Healthcare Provider Details

I. General information

NPI: 1942358049
Provider Name (Legal Business Name): SUJATHA RAMESH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 CLAYTON RD STE 204
SAINT LOUIS MO
63117-1342
US

IV. Provider business mailing address

P.O.BOX 16864
ST. LOUIS MO
63105-9998
US

V. Phone/Fax

Practice location:
  • Phone: 314-302-0196
  • Fax:
Mailing address:
  • Phone: 314-302-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2006023866
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: