Healthcare Provider Details

I. General information

NPI: 1740723634
Provider Name (Legal Business Name): MAUREEN ALFERMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 PRINCETON AVE
SAINT LOUIS MO
63130-3028
US

IV. Provider business mailing address

7241 PRINCETON AVE
SAINT LOUIS MO
63130-3028
US

V. Phone/Fax

Practice location:
  • Phone: 314-210-2255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2011001428
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: