MEDICARE: MONICA RENEE PETERS BCBA, LBA

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	103K00000X	Behavior Analyst	2022034064	MO

General Provider Information

NPI Number	:	1538881438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA RENEE PETERS BCBA, LBA

Provider Business Mailing Address
First Line	:	4917 EICHELBERGER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4917 EICHELBERGER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3234
Country	:	US
Telephone Number	:	314-650-2247
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	11/20/2024

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