Healthcare Provider Details

I. General information

NPI: 1487592580
Provider Name (Legal Business Name): SARAH PUDIWITR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 NORTHUMBERLAND DR
SAINT LOUIS MO
63137-1498
US

IV. Provider business mailing address

1030 CHILDRESS AVE
SAINT LOUIS MO
63139-3374
US

V. Phone/Fax

Practice location:
  • Phone: 314-869-2505
  • Fax:
Mailing address:
  • Phone: 954-684-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: