ELIZABETH PROVENCIO

SAINT LOUIS, MO
NPI1457182214
Former NameELIZABETH PIKE
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy235Z00000X Speech-Language Pathologist,
(Licence: AZ  SLP6047)
Enumeration Date2024-08-12
Last Update Date2024-08-12
Business Address
ELIZABETH PROVENCIO
4554 LACLEDE AVE APT 308
SAINT LOUIS, MO 63108-2147
Phone number: 217-553-1786
Mailing Address
ELIZABETH PROVENCIO
1 BOSCHERT CREEK DR
SAINT PETERS, MO 63376-5951
Phone number: 575-635-2516
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