Healthcare Provider Details

I. General information

NPI: 1396522975
Provider Name (Legal Business Name): MRS. HANNAH ROACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MIAMI ST
SAINT LOUIS MO
63118-4053
US

IV. Provider business mailing address

2315 MIAMI ST
SAINT LOUIS MO
63118-4053
US

V. Phone/Fax

Practice location:
  • Phone: 314-252-0602
  • Fax:
Mailing address:
  • Phone: 314-252-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: