Healthcare Provider Details

I. General information

NPI: 1639085806
Provider Name (Legal Business Name): ALEXIS MARIE HOUSTON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 CLAYTON RD
SAINT LOUIS MO
63131-2599
US

IV. Provider business mailing address

2120 CASTLEBROOK DR
IMPERIAL MO
63052-3816
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026003888
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: