Healthcare Provider Details

I. General information

NPI: 1104759646
Provider Name (Legal Business Name): KRISTEN LANDGRAF MED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 GARDENVIEW OFFICE PKWY
SAINT LOUIS MO
63141-5917
US

IV. Provider business mailing address

967 GARDENVIEW OFFICE PKWY
SAINT LOUIS MO
63141-5917
US

V. Phone/Fax

Practice location:
  • Phone: 314-561-9757
  • Fax: 314-561-9050
Mailing address:
  • Phone: 314-561-9757
  • Fax: 314-561-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2022040475
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: