Healthcare Provider Details

I. General information

NPI: 1558425801
Provider Name (Legal Business Name): PATRICK J. OPENLANDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 S KIRKWOOD RD UNIT 104B
KIRKWOOD MO
63122-6166
US

IV. Provider business mailing address

338 S KIRKWOOD RD UNIT 104B
KIRKWOOD MO
63122-6166
US

V. Phone/Fax

Practice location:
  • Phone: 314-984-0068
  • Fax: 314-984-0338
Mailing address:
  • Phone: 314-984-0068
  • Fax: 314-984-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01129
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY01129
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: