Healthcare Provider Details

I. General information

NPI: 1306771464
Provider Name (Legal Business Name): DYMOND RATCLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 SUNSET OFFICE DR
SAINT LOUIS MO
63127-1015
US

IV. Provider business mailing address

4321 MORGANFORD RD APT 5
SAINT LOUIS MO
63116-1558
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-3456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number4915040
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: