MEDICARE: DANA HAZLETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	2024036472	MO

General Provider Information

NPI Number	:	1235937822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA HAZLETT

Provider Business Mailing Address
First Line	:	5110 EXETER AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-4340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1731 S BROADWAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-4050
Country	:	US
Telephone Number	:	314-231-2337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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Directions to “ DANA HAZLETT ” Practice Location

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