Healthcare Provider Details

I. General information

NPI: 1710266184
Provider Name (Legal Business Name): CENTRAL INSTITUTE FOR TEH DEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S TAYLOR AVE
SAINT LOUIS MO
63110-1567
US

IV. Provider business mailing address

825 S TAYLOR AVE
SAINT LOUIS MO
63110-1567
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-0134
  • Fax: 314-977-0023
Mailing address:
  • Phone: 314-977-0134
  • Fax: 314-977-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberN/A
License Number State

VIII. Authorized Official

Name: JODI LARSON
Title or Position: FINANCE OFFICE
Credential:
Phone: 314-977-0227