Healthcare Provider Details

I. General information

NPI: 1568667665
Provider Name (Legal Business Name): ST. JOSEPH INSTITUTE FOR THE DEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 STRASSNER
BRENTWOOD MO
63144
US

IV. Provider business mailing address

1314 STRASSNER
BRENTWOOD MO
63144
US

V. Phone/Fax

Practice location:
  • Phone: 636-532-3211
  • Fax: 636-532-4560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateMO

VIII. Authorized Official

Name: MRS. CHERYL LYNN BROEKELMANN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 636-532-3211