Healthcare Provider Details

I. General information

NPI: 1528215852
Provider Name (Legal Business Name): CAROLYN A BEQUETTE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD DEPT OTOLARYNGOLOGY, STE 140
SAINT LOUIS MO
63141-6859
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7509
  • Fax: 314-453-0489
Mailing address:
  • Phone: 314-362-7509
  • Fax: 314-453-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2001019042
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: