Healthcare Provider Details

I. General information

NPI: 1083751218
Provider Name (Legal Business Name): MARY LEIGH ZWART M.A., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 OLD MILL PKWY
SAINT PETERS MO
63376-6550
US

IV. Provider business mailing address

4140 OLD MILL PKWY
SAINT PETERS MO
63376-6550
US

V. Phone/Fax

Practice location:
  • Phone: 636-926-2700
  • Fax: 636-447-4919
Mailing address:
  • Phone: 636-926-2700
  • Fax: 636-447-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2006018892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: