Healthcare Provider Details

I. General information

NPI: 1306415054
Provider Name (Legal Business Name): KATHERINE ELISE KOCAK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 OLD DES PERES RD
DES PERES MO
63131-1865
US

IV. Provider business mailing address

PO BOX 14369
SAINT LOUIS MO
63178-4369
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-0077
  • Fax:
Mailing address:
  • Phone: 314-729-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2022023804
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: