Provider Demographics
NPI:1417079534
Name:BOCK, KAYE (MSW)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 LADUE RD STE 337
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2096
Mailing Address - Country:US
Mailing Address - Phone:314-754-3242
Mailing Address - Fax:314-446-3052
Practice Address - Street 1:8820 LADUE RD STE 337
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2096
Practice Address - Country:US
Practice Address - Phone:314-754-3242
Practice Address - Fax:314-446-3052
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493251003Medicaid
PTAN:MA2106Medicare PIN