Healthcare Provider Details

I. General information

NPI: 1821656208
Provider Name (Legal Business Name): ST. LOUIS COUNTY DEPT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N HANLEY RD
SAINT LOUIS MO
63134-2003
US

IV. Provider business mailing address

6121 N HANLEY RD
SAINT LOUIS MO
63134-2003
US

V. Phone/Fax

Practice location:
  • Phone: 314-615-0557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH BECKER
Title or Position: REGISTERED DIETETIAN
Credential:
Phone: 314-615-0557