Provider Demographics
NPI:1629788187
Name:RUSTEMEYER, GEORGEAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGEAN
Middle Name:
Last Name:RUSTEMEYER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 FERN RIDGE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-4405
Mailing Address - Country:US
Mailing Address - Phone:314-275-8599
Mailing Address - Fax:
Practice Address - Street 1:1215 FERN RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-4405
Practice Address - Country:US
Practice Address - Phone:314-690-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0010921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical