| NPI | 1528415536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY JANE DICKERMAN Billing Manager 314-849-0450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MO 2015002634) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2016-05-19 |