Healthcare Provider Details

I. General information

NPI: 1447630629
Provider Name (Legal Business Name): MS. CATHERINE DULLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 COEUR DE VILLE DR REHAB DEPARTMENT
SAINT LOUIS MO
63141-6603
US

IV. Provider business mailing address

2127 INNERBELT BUSINESS CENTER DR SUITE 320
SAINT LOUIS MO
63114-5700
US

V. Phone/Fax

Practice location:
  • Phone: 314-453-7311
  • Fax: 314-548-6755
Mailing address:
  • Phone: 314-898-3944
  • Fax: 314-506-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number00816
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: