Healthcare Provider Details

I. General information

NPI: 1598375065
Provider Name (Legal Business Name): MRS. HEATHER ANN KULASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 HALLIDAY AVE APT 2E
SAINT LOUIS MO
63118-1264
US

IV. Provider business mailing address

3207 HALLIDAY AVE APT 2E
SAINT LOUIS MO
63118-1264
US

V. Phone/Fax

Practice location:
  • Phone: 314-398-6074
  • Fax:
Mailing address:
  • Phone: 314-398-6074
  • 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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: