Healthcare Provider Details

I. General information

NPI: 1871625582
Provider Name (Legal Business Name): EASTER SEALS MIDWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11933 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3203
US

IV. Provider business mailing address

11933 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3203
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-7100
  • Fax: 314-394-4007
Mailing address:
  • Phone: 314-394-7100
  • Fax: 314-394-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2205030351
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1999140934
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number001967
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2010005293
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2001015378
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number118073
License Number StateMO
# 10
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFF ARLEDGE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 314-394-7020