Healthcare Provider Details

I. General information

NPI: 1326954587
Provider Name (Legal Business Name): JOHN THEODORE MEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N TUCKER BLVD
SAINT LOUIS MO
63101-1114
US

IV. Provider business mailing address

800 N TUCKER BLVD
SAINT LOUIS MO
63101-1114
US

V. Phone/Fax

Practice location:
  • Phone: 314-802-0700
  • Fax:
Mailing address:
  • Phone: 314-802-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021029755
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: