Healthcare Provider Details

I. General information

NPI: 1336798354
Provider Name (Legal Business Name): EMILY MARIE HORNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4066 DUNNICA AVE
SAINT LOUIS MO
63116-3510
US

IV. Provider business mailing address

118 N 2ND ST
SAINT CHARLES MO
63301-2832
US

V. Phone/Fax

Practice location:
  • Phone: 636-224-1700
  • Fax: 314-535-5917
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-946-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2017129840
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: