Provider Demographics
NPI:1023593928
Name:SMITH-FERGUSON, CHLOE CIARRA (MSW, LCSW)
Entity type:Individual
Prefix:MISS
First Name:CHLOE
Middle Name:CIARRA
Last Name:SMITH-FERGUSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 SUMMIT KNOLL DR APT I
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-7530
Mailing Address - Country:US
Mailing Address - Phone:618-367-6586
Mailing Address - Fax:
Practice Address - Street 1:4222 SUMMIT KNOLL DR APT I
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-7530
Practice Address - Country:US
Practice Address - Phone:618-367-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0214641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical