Provider Demographics
NPI:1740266345
Name:ALEWEL, PATRICIA A (MS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:ALEWEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:BAUMBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1303 EDGEWOOD DR
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1943
Mailing Address - Country:US
Mailing Address - Phone:573-636-0025
Mailing Address - Fax:573-636-0025
Practice Address - Street 1:1303 EDGEWOOD DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1943
Practice Address - Country:US
Practice Address - Phone:573-636-0025
Practice Address - Fax:573-636-0025
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497841627Medicaid
MO990301545Medicare ID - Type UnspecifiedMEDICARE EAST