Provider Demographics
NPI:1205654605
Name:TWEEDDALE, CATHERINE RUTH
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RUTH
Last Name:TWEEDDALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3516
Mailing Address - Country:US
Mailing Address - Phone:352-212-4800
Mailing Address - Fax:
Practice Address - Street 1:15455 CONWAY RD STE 117
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2022
Practice Address - Country:US
Practice Address - Phone:636-675-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024003444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health