Healthcare Provider Details

I. General information

NPI: 1467384834
Provider Name (Legal Business Name): CATHY ANN PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHY ANN PORTER

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 INNERBELT BUSINESS CENTER DR
OVERLAND MO
63114-5760
US

IV. Provider business mailing address

412 WASHINGTON ST
FARMER CITY IL
61842-1348
US

V. Phone/Fax

Practice location:
  • Phone: 314-202-4002
  • Fax:
Mailing address:
  • Phone: 636-232-7106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026022903
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: