Healthcare Provider Details

I. General information

NPI: 1265448542
Provider Name (Legal Business Name): JOHN D. WRIGHT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 614-251-4683
  • Fax: 314-251-4380
Mailing address:
  • Phone: 614-251-4683
  • Fax: 314-251-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2006006605
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: