Provider Demographics
NPI:1538669619
Name:WERKMEISTER, SHILOH ANNE (MAC, PLPC)
Entity Type:Individual
Prefix:
First Name:SHILOH
Middle Name:ANNE
Last Name:WERKMEISTER
Suffix:
Gender:F
Credentials:MAC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1247
Mailing Address - Country:US
Mailing Address - Phone:636-295-1974
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1247
Practice Address - Country:US
Practice Address - Phone:636-295-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018004375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional