Healthcare Provider Details

I. General information

NPI: 1053674630
Provider Name (Legal Business Name): MERCY CHILDRENS THERAPY AND DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 N NEW BALLAS RD
SAINT LOUIS MO
63141-6713
US

IV. Provider business mailing address

641 N NEW BALLAS RD
SAINT LOUIS MO
63141-6713
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-3345
  • Fax: 314-872-3180
Mailing address:
  • Phone: 314-872-3345
  • Fax: 314-872-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY DUNGER
Title or Position: EXECUTIVE DIRECTOR - FINANCE
Credential:
Phone: 314-364-3707