Healthcare Provider Details

I. General information

NPI: 1285564492
Provider Name (Legal Business Name): ELLA GRACE LANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14855 NORTH OUTER 40 RD
CHESTERFIELD MO
63017-2026
US

IV. Provider business mailing address

15477 ELK RIDGE LN APT 8
CHESTERFIELD MO
63017-5339
US

V. Phone/Fax

Practice location:
  • Phone: 217-202-4004
  • Fax:
Mailing address:
  • Phone: 248-990-6284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: