Healthcare Provider Details

I. General information

NPI: 1891628947
Provider Name (Legal Business Name): OLIVIA BELLE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DOCUMENT DR
SAINT LOUIS MO
63114-6100
US

IV. Provider business mailing address

5 DOCUMENT DR
SAINT LOUIS MO
63114-6100
US

V. Phone/Fax

Practice location:
  • Phone: 314-970-9115
  • Fax: 314-970-9117
Mailing address:
  • Phone: 314-970-9115
  • Fax: 314-970-9117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026021778
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: