Provider Demographics
NPI:1558570804
Name:GOUAUX, SUE MILBURN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:MILBURN
Last Name:GOUAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 BONHOMME AVE
Mailing Address - Street 2:321
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3515
Mailing Address - Country:US
Mailing Address - Phone:314-726-0011
Mailing Address - Fax:314-721-7109
Practice Address - Street 1:8000 BONHOMME AVE
Practice Address - Street 2:321
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3515
Practice Address - Country:US
Practice Address - Phone:314-726-0011
Practice Address - Fax:314-721-7109
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0003931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000077746Medicare PIN