Healthcare Provider Details

I. General information

NPI: 1649122318
Provider Name (Legal Business Name): NEUROWISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10435 CLAYTON RD STE 200
SAINT LOUIS MO
63131-2930
US

IV. Provider business mailing address

10435 CLAYTON RD STE 200
SAINT LOUIS MO
63131-2930
US

V. Phone/Fax

Practice location:
  • Phone: 618-559-3692
  • Fax:
Mailing address:
  • Phone: 618-559-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: STACEY BEARDEN
Title or Position: DIRECTOR CLIENT RELATIONS
Credential:
Phone: 303-929-2001