Healthcare Provider Details

I. General information

NPI: 1487350773
Provider Name (Legal Business Name): KRISTINA J HOAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 CRAIGSHIRE RD
SAINT LOUIS MO
63146-4036
US

IV. Provider business mailing address

2055 CRAIGSHIRE RD
SAINT LOUIS MO
63146-4036
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-0506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: