Provider Demographics
NPI:1053979476
Name:SAUCER, ELLERIE (MA, PLPC)
Entity type:Individual
Prefix:
First Name:ELLERIE
Middle Name:
Last Name:SAUCER
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 COTTLEVILLE PKWY APT 107
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3397
Mailing Address - Country:US
Mailing Address - Phone:972-971-4449
Mailing Address - Fax:
Practice Address - Street 1:835 W TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2300
Practice Address - Country:US
Practice Address - Phone:972-971-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019009235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional