Healthcare Provider Details

I. General information

NPI: 1760397368
Provider Name (Legal Business Name): MICHELE ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 LOUGHBOROUGH AVE
SAINT LOUIS MO
63111-2727
US

IV. Provider business mailing address

746 VILLAGE WOOD CT
BALLWIN MO
63021-6148
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-1349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2026033651
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: