Provider Demographics
NPI:1437318037
Name:PONIEWAZ, ERIN M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:M
Last Name:PONIEWAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 US HWY 61
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019
Mailing Address - Country:US
Mailing Address - Phone:636-933-1205
Mailing Address - Fax:636-933-1837
Practice Address - Street 1:1400 US HWY 61
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-933-1205
Practice Address - Fax:636-933-1837
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional