Healthcare Provider Details

I. General information

NPI: 1407685282
Provider Name (Legal Business Name): AVERY CROFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ELBRIDGE PAYNE RD
CHESTERFIELD MO
63017-8538
US

IV. Provider business mailing address

103 LITHIA AVE
WEBSTER GROVES MO
63119-1414
US

V. Phone/Fax

Practice location:
  • Phone: 636-898-2060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: