Provider Demographics
NPI:1962416743
Name:MATTINGLY, ANDREA MICHELE (BA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 OLIVE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2303
Mailing Address - Country:US
Mailing Address - Phone:314-206-3930
Mailing Address - Fax:
Practice Address - Street 1:343 S KIRKWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6195
Practice Address - Country:US
Practice Address - Phone:314-206-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker