Healthcare Provider Details

I. General information

NPI: 1457263204
Provider Name (Legal Business Name): KATE ELIZABETH HEERSINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 OLD MILL PKWY
SAINT PETERS MO
63376-6550
US

IV. Provider business mailing address

2932 OSSENFORT RD
WILDWOOD MO
63038-1718
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-7785
  • Fax:
Mailing address:
  • Phone: 636-222-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2024044814
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: