Healthcare Provider Details

I. General information

NPI: 1629675806
Provider Name (Legal Business Name): JULIE LORRAINE PREUSS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N WARSON RD
SAINT LOUIS MO
63132-1800
US

IV. Provider business mailing address

1177 N WARSON RD
SAINT LOUIS MO
63132-1800
US

V. Phone/Fax

Practice location:
  • Phone: 314-817-2262
  • Fax: 314-569-3656
Mailing address:
  • Phone: 314-817-2262
  • Fax: 314-569-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12044856
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: