Healthcare Provider Details

I. General information

NPI: 1811854334
Provider Name (Legal Business Name): ASHLEY BECKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 DOUBLE TREE DR
IMPERIAL MO
63052-4503
US

IV. Provider business mailing address

5021 DOUBLE TREE DR
IMPERIAL MO
63052-4503
US

V. Phone/Fax

Practice location:
  • Phone: 314-556-9363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number209034288
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: