Healthcare Provider Details

I. General information

NPI: 1225786908
Provider Name (Legal Business Name): KATHRYN KLATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15740 SOUTH OUTER ROAD
ST. LOUIS MO
63017
US

IV. Provider business mailing address

15740 SOUTH OUTER ROAD
ST. LOUIS MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 636-346-1789
  • Fax:
Mailing address:
  • Phone: 636-346-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011032205
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: