Healthcare Provider Details

I. General information

NPI: 1770006405
Provider Name (Legal Business Name): KAYLA DAWN HOFFMEISTER MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DEPAUL DR 1639
BRIDGETON MO
63044
US

IV. Provider business mailing address

472 HONEYSUCKLE CREEK DR
WENTZVILLE MO
63385-5610
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6000
  • Fax: 314-344-7348
Mailing address:
  • Phone: 636-577-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2015019204
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: