Healthcare Provider Details

I. General information

NPI: 1477081875
Provider Name (Legal Business Name): ALLISON COLEMAN BAETEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 LANDMARK PARKWAY DR STE 201
SAINT LOUIS MO
63127-1665
US

IV. Provider business mailing address

607 S NEW BALLAS RD STE 2300
SAINT LOUIS MO
63141-8234
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-3828
  • Fax:
Mailing address:
  • Phone: 314-722-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2017016566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: