Healthcare Provider Details

I. General information

NPI: 1922666585
Provider Name (Legal Business Name): COURTNEY M DELAU AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
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

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

V. Phone/Fax

Practice location:
  • Phone: 314-843-3828
  • Fax: 314-843-3052
Mailing address:
  • Phone: 314-843-3828
  • Fax: 314-843-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2022008791
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: