Healthcare Provider Details

I. General information

NPI: 1679465769
Provider Name (Legal Business Name): CAROLYN SINAK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD STE 150
SAINT LOUIS MO
63122-7251
US

IV. Provider business mailing address

5507 BISCHOFF AVE
SAINT LOUIS MO
63110-2903
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax:
Mailing address:
  • Phone: 314-917-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2025023011
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: