Healthcare Provider Details

I. General information

NPI: 1598912990
Provider Name (Legal Business Name): PAMELA KOPROWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL RM 3 S 23
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL RM 3 S 23
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6171
  • Fax:
Mailing address:
  • Phone: 314-454-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00791
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: