Provider Demographics
NPI:1780144022
Name:GOEWERT, MICHELLE (MED, PLBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GOEWERT
Suffix:
Gender:F
Credentials:MED, PLBA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:AUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 WESTWIND ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1514
Mailing Address - Country:US
Mailing Address - Phone:314-600-2782
Mailing Address - Fax:314-845-3901
Practice Address - Street 1:4051 JEFFCO BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-4261
Practice Address - Country:US
Practice Address - Phone:636-223-0070
Practice Address - Fax:636-323-2042
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019007225103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst