Healthcare Provider Details

I. General information

NPI: 1750105052
Provider Name (Legal Business Name): DANIEL WILLIAM LAGONI ED.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 CLAYTON RD
SAINT LOUIS MO
63131-2599
US

IV. Provider business mailing address

4909 LACLEDE AVE APT 1701
SAINT LOUIS MO
63108-1425
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-3970
  • Fax:
Mailing address:
  • Phone: 847-833-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: