Provider Demographics
NPI:1104949056
Name:DENNIS, PATRICIA KYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KYLE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N MERAMEC AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3750
Mailing Address - Country:US
Mailing Address - Phone:314-862-5151
Mailing Address - Fax:
Practice Address - Street 1:141 N MERAMEC AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3750
Practice Address - Country:US
Practice Address - Phone:314-862-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0003031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOSW000303OtherLCSW LICENSE NUMBER
MOSW000303OtherLCSW LICENSE NUMBER