Provider Demographics
NPI:1275138331
Name:SCHOONOVER, NICHOLE R (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:R
Last Name:SCHOONOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S OLD ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4254
Mailing Address - Country:US
Mailing Address - Phone:417-569-7195
Mailing Address - Fax:
Practice Address - Street 1:502 S OLD ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-4254
Practice Address - Country:US
Practice Address - Phone:417-569-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker