MEDICARE: CHE SALON

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	174400000X	Specialist	103943	MO

General Provider Information

NPI Number	:	1285135848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHE SALON

Provider Business Mailing Address
First Line	:	8416 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2816
Country	:	US
Telephone Number	:	314-395-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	8416 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2816
Country	:	US
Telephone Number	:	314-395-1080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA MICHELLE WILLIAMS
Credential	:	COSMETOLOGIST
Telephone Number	:	314-395-1080

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	02/27/2018

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Directions to “CHE SALON ” Practice Location

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