Healthcare Provider Details

I. General information

NPI: 1457745226
Provider Name (Legal Business Name): MARY HOERNER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10176 CORPORATE SQUARE DR SUITE 220
SAINT LOUIS MO
63132-2924
US

IV. Provider business mailing address

10176 CORPORATE SQUARE DR SUITE 220
SAINT LOUIS MO
63132-2924
US

V. Phone/Fax

Practice location:
  • Phone: 314-395-9375
  • Fax: 314-395-9381
Mailing address:
  • Phone: 314-395-9375
  • Fax: 314-395-9381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: