Healthcare Provider Details

I. General information

NPI: 1184025124
Provider Name (Legal Business Name): KATHRYN JO SCHOTT M.A.CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 LINDELL BLVD
SAINT LOUIS MO
63108-1510
US

IV. Provider business mailing address

1579 OAKGLEN DR
FENTON MO
63026-7020
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-8700
  • Fax:
Mailing address:
  • Phone: 314-623-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01526
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: