Healthcare Provider Details

I. General information

NPI: 1770366098
Provider Name (Legal Business Name): MS. MORGAN AMANDA HERBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 HOMEFIELD BLVD
O FALLON MO
63366-4482
US

IV. Provider business mailing address

210 VIRGIL ST
O FALLON MO
63366-2644
US

V. Phone/Fax

Practice location:
  • Phone: 636-542-7050
  • Fax:
Mailing address:
  • Phone: 636-281-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2023032960
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: