Healthcare Provider Details

I. General information

NPI: 1134672561
Provider Name (Legal Business Name): ELIZABETH MATHIS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EXECUTIVE PARKWAY DR STE 120
SAINT LOUIS MO
63141-6369
US

IV. Provider business mailing address

14258 CYPRESS HILL DR
CHESTERFIELD MO
63017-2845
US

V. Phone/Fax

Practice location:
  • Phone: 314-828-1443
  • Fax:
Mailing address:
  • Phone: 908-752-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2016023486
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: