Healthcare Provider Details

I. General information

NPI: 1437637329
Provider Name (Legal Business Name): CONNER TIEARRA HURT MA, SLP-CF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 WESTLINE INDUSTRIAL DR STE 201
SAINT LOUIS MO
63146-3209
US

IV. Provider business mailing address

9620 YORKSHIRE ESTATES DR
SAINT LOUIS MO
63126-1944
US

V. Phone/Fax

Practice location:
  • Phone: 866-433-9555
  • Fax:
Mailing address:
  • Phone: 314-817-6487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2018027180
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: