Healthcare Provider Details

I. General information

NPI: 1124508288
Provider Name (Legal Business Name): MEGAN VIOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 OFFICE PKWY
SAINT LOUIS MO
63141-7103
US

IV. Provider business mailing address

9415 STERLING PL
AFFTON MO
63123-4549
US

V. Phone/Fax

Practice location:
  • Phone: 314-750-0068
  • Fax:
Mailing address:
  • Phone: 617-872-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number2018027338
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: