| NPI | 1811108608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENA R. VANDEVENTER Office Manager 573-888-9190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO R0582) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 02042) |
| 174400000X Specialist (Licence: MO 01506) | |
| 235Z00000X Speech-Language Pathologist, (Licence: MO 107027) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-11-15 |