Healthcare Provider Details

I. General information

NPI: 1558716555
Provider Name (Legal Business Name): LAUREN SCALISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 S GRAND BLVD APT 105
SAINT LOUIS MO
63104-1512
US

IV. Provider business mailing address

2017 S GRAND BLVD APT 105
SAINT LOUIS MO
63104-1512
US

V. Phone/Fax

Practice location:
  • Phone: 630-450-3521
  • Fax:
Mailing address:
  • Phone: 630-450-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: