Healthcare Provider Details

I. General information

NPI: 1285650598
Provider Name (Legal Business Name): GITRY HEYDEBRAND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ STE 17301
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8134
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3072
  • Fax: 314-286-1777
Mailing address:
  • Phone: 314-362-3072
  • Fax: 314-286-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY01789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: