Healthcare Provider Details

I. General information

NPI: 1649087974
Provider Name (Legal Business Name): ANDREW JOSEPH ALLMEROTH BS SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 10TH ST
FULTON MO
65251-2009
US

IV. Provider business mailing address

5804 PEBBLE CREEK DR
WARDSVILLE MO
65101-8325
US

V. Phone/Fax

Practice location:
  • Phone: 573-590-8200
  • Fax:
Mailing address:
  • Phone: 573-292-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2024038705
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: