Healthcare Provider Details

I. General information

NPI: 1780175588
Provider Name (Legal Business Name): EMILY SCHURMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 CRAIG RD STE 109
SAINT LOUIS MO
63146-4758
US

IV. Provider business mailing address

1017 CLARK DR
FENTON MO
63026-5043
US

V. Phone/Fax

Practice location:
  • Phone: 800-780-6545
  • Fax:
Mailing address:
  • Phone: 314-277-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: