Healthcare Provider Details

I. General information

NPI: 1417741927
Provider Name (Legal Business Name): SANDRA E NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 MCREE AVE
SAINT LOUIS MO
63110-2019
US

IV. Provider business mailing address

3925 BIRKEMEIER DR
FLORISSANT MO
63034-2104
US

V. Phone/Fax

Practice location:
  • Phone: 314-776-3300
  • Fax:
Mailing address:
  • Phone: 314-614-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLIFETIME
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: