| Side By Side Wellness Llc | |
|
1100 Rock Creek Elementary School Dr O Fallon MO 63366-7577 | |
| (636) 294-5787 | |
| Not Available |
| Full Name | Side By Side Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1100 Rock Creek Elementary School Dr, O Fallon, Missouri |
| Authorized Official Name and Position | Shera Baker (OWNER) |
| Authorized Official Contact | 6362945787 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Side By Side Wellness Llc 1100 Rock Creek Elementary School Dr O Fallon MO 63366-7577 Ph: (636) 294-5787 | Side By Side Wellness Llc 1100 Rock Creek Elementary School Dr O Fallon MO 63366-7577 Ph: (636) 294-5787 |
| NPI Number | 1386112035 |
|---|---|
| Provider Enumeration Date | 11/09/2018 |
| Last Update Date | 05/27/2020 |
| Certification Date | 05/27/2020 |
| Medicare PECOS PAC ID | 0244567675 |
|---|---|
| Medicare Enrollment ID | O20190808000988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386112035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Heather O St. Peter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306378765 PECOS PAC ID: 7618238692 Enrollment ID: I20180308001336 |
| Provider Name | Katie E Kessler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508306622 PECOS PAC ID: 0244567683 Enrollment ID: I20190808001752 |
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