Healthcare Provider Details

I. General information

NPI: 1811996689
Provider Name (Legal Business Name): MEENA DHAWAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11709 OLD BALLAS RD SUITE 103
SAINT LOUIS MO
63141-7029
US

IV. Provider business mailing address

5000 CEDAR PLAZA PARKWAY STE 350
SAINT LOUIS MO
63128-3441
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-8950
  • Fax: 314-567-5574
Mailing address:
  • Phone: 314-843-4333
  • Fax: 314-843-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01518
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: