Healthcare Provider Details

I. General information

NPI: 1598988669
Provider Name (Legal Business Name): MRS. VERA GOODLOE RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 GRAHAM RD
FLORISSANT MO
63031-7051
US

IV. Provider business mailing address

1280 GARDEN VILLAGE DR
FLORISSANT MO
63031-1951
US

V. Phone/Fax

Practice location:
  • Phone: 314-837-6336
  • Fax: 314-839-4044
Mailing address:
  • Phone: 314-837-4676
  • Fax: 314-839-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: