Provider Demographics
NPI:1376662304
Name:DUER, SAMUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:DUER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N ENTERPRISE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-4106
Mailing Address - Country:US
Mailing Address - Phone:573-204-9200
Mailing Address - Fax:573-204-9203
Practice Address - Street 1:160 N ENTERPRISE LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-4106
Practice Address - Country:US
Practice Address - Phone:573-204-9200
Practice Address - Fax:573-204-9203
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2366-C1041C0700X
MO20090258471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical