Healthcare Provider Details

I. General information

NPI: 1194667253
Provider Name (Legal Business Name): TARA LINNEMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 WYATT DR
SAINT PETERS MO
63376-7173
US

IV. Provider business mailing address

582 WYATT DR
SAINT PETERS MO
63376-7173
US

V. Phone/Fax

Practice location:
  • Phone: 636-634-5359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: