Healthcare Provider Details

I. General information

NPI: 1679617120
Provider Name (Legal Business Name): KARENA L ROMSTAD-EOFF MA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SHERRY RD
LABADIE MO
63055-1042
US

IV. Provider business mailing address

740 HAWK RUN DR
O FALLON MO
63368-3780
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-7810
  • Fax:
Mailing address:
  • Phone: 636-239-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105117
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: