Healthcare Provider Details

I. General information

NPI: 1922144427
Provider Name (Legal Business Name): BETH ANN HOLSTAD MS, FAAA, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 S 40 DR
SAINT LOUIS MO
63141-8820
US

IV. Provider business mailing address

12300 S 40 DR
SAINT LOUIS MO
63141-8820
US

V. Phone/Fax

Practice location:
  • Phone: 314-692-7172
  • Fax: 314-692-8544
Mailing address:
  • Phone: 314-692-7172
  • Fax: 314-692-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number02020
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number001202
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: