Healthcare Provider Details

I. General information

NPI: 1851044564
Provider Name (Legal Business Name): THE BIOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4471 OLIVE ST
SAINT LOUIS MO
63108-1807
US

IV. Provider business mailing address

4471 OLIVE ST
SAINT LOUIS MO
63108-1807
US

V. Phone/Fax

Practice location:
  • Phone: 314-401-3714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY SCHILTZ
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 314-401-3714