Healthcare Provider Details

I. General information

NPI: 1962522763
Provider Name (Legal Business Name): DEAF SERVICES 2004, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10537 STEPHENSON DR
SAINT LOUIS MO
63128-1238
US

IV. Provider business mailing address

10537 STEPHENSON DR
SAINT LOUIS MO
63128-1238
US

V. Phone/Fax

Practice location:
  • Phone: 314-229-2922
  • Fax: 314-849-1066
Mailing address:
  • Phone: 314-229-2922
  • Fax: 314-849-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number1999137062
License Number StateMO

VIII. Authorized Official

Name: SUSAN POWER
Title or Position: OWNER
Credential:
Phone: 314-229-2922