Healthcare Provider Details

I. General information

NPI: 1255446803
Provider Name (Legal Business Name): SUSAN ALSTAT MS,CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N WARSON RD
SAINT LOUIS MO
63132-1810
US

IV. Provider business mailing address

1589 ARCHER DR
ARNOLD MO
63010-1111
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146 005154
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146005154
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: