Provider Demographics
NPI:1497866404
Name:PATHWAYS FOR AGING, INC.
Entity Type:Organization
Organization Name:PATHWAYS FOR AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KRAUSE-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:314-395-7560
Mailing Address - Street 1:745 CRAIG ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7122
Mailing Address - Country:US
Mailing Address - Phone:314-395-7560
Mailing Address - Fax:314-395-7563
Practice Address - Street 1:745 CRAIG ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7122
Practice Address - Country:US
Practice Address - Phone:314-395-7560
Practice Address - Fax:314-395-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW 0010881041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000014307Medicare UPIN