Healthcare Provider Details

I. General information

NPI: 1780144022
Provider Name (Legal Business Name): MICHELLE GOEWERT MED, PLBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE AUER

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 JEFFCO BLVD STE 3
ARNOLD MO
63010-4261
US

IV. Provider business mailing address

309 WESTWIND ESTATES LN
VALLEY PARK MO
63088-1514
US

V. Phone/Fax

Practice location:
  • Phone: 636-223-0070
  • Fax: 636-323-2042
Mailing address:
  • Phone: 314-600-2782
  • Fax: 314-845-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2019007225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: