Healthcare Provider Details

I. General information

NPI: 1881842680
Provider Name (Legal Business Name): BRENDA J TOLBERT M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SOUTH NEW BALLAS ROAD SUITE 320E
ST. LOUIS MO
63141-8789
US

IV. Provider business mailing address

4303 AUGUSTA MANOR CT
FLORISSANT MO
63034-3475
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-4868
  • Fax: 314-567-7639
Mailing address:
  • Phone: 314-368-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number01429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: