Healthcare Provider Details

I. General information

NPI: 1043808645
Provider Name (Legal Business Name): SAMANTHA A GEREAU SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA ANDERSON SLP

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 11TH ST
SAINT LOUIS MO
63101-1015
US

IV. Provider business mailing address

308 WINDING BLUFFS CT
FENTON MO
63026-5500
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-3332
  • Fax:
Mailing address:
  • Phone: 772-403-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2024012127
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19673
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: