Provider Demographics
NPI:1306001201
Name:MCGEE-GNUSE, KIMBERLY DAWN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:MCGEE-GNUSE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:GNUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:97 N HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2180
Mailing Address - Country:US
Mailing Address - Phone:636-397-4514
Mailing Address - Fax:
Practice Address - Street 1:9200 WATSON RD
Practice Address - Street 2:STE. G101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1528
Practice Address - Country:US
Practice Address - Phone:314-544-3800
Practice Address - Fax:314-843-0552
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12328048OtherCAQH