Healthcare Provider Details

I. General information

NPI: 1689153082
Provider Name (Legal Business Name): SEW ST. LOUIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 N WATERFORD DR
FLORISSANT MO
63033
US

IV. Provider business mailing address

2172 N WATERFORD DR
FLORISSANT MO
63033-2301
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-9000
  • Fax:
Mailing address:
  • Phone: 314-942-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: KENDRA COSEY
Title or Position: OWNER/CERTIFIEDHAIR LOSS SPECIALIST
Credential:
Phone: 314-942-9000