Healthcare Provider Details

I. General information

NPI: 1063359263
Provider Name (Legal Business Name): WASHINGTON UNIVERSITY SCHOOL OF MEDICI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 FOREST PARK AVE STE 301
SAINT LOUIS MO
63108-2215
US

IV. Provider business mailing address

4488 FOREST PARK AVE STE 301
SAINT LOUIS MO
63108-2215
US

V. Phone/Fax

Practice location:
  • Phone: 314-369-9430
  • Fax: 314-747-7060
Mailing address:
  • Phone: 314-369-9430
  • Fax: 314-747-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY CATHERINE SIGURDSON
Title or Position: RESEARCH COORDINATOR
Credential: RN, BSCN, MHSC
Phone: 314-369-9430