MEDICARE: DR. STEPHEN G VIOLA PH.D.

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	103TS0200X	School Psychologist		MO

General Provider Information

NPI Number	:	1770755613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN G VIOLA PH.D.

Provider Business Mailing Address
First Line	:	2020 WASHINGTON AVE
Second Line	:	#411
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1650
Country	:	US
Telephone Number	:	314-588-8975
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 WASHINGTON AVE
Second Line	:	#411
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1650
Country	:	US
Telephone Number	:	314-588-8975
Fax Number	:

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

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/14/2008

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