Healthcare Provider Details

I. General information

NPI: 1720204837
Provider Name (Legal Business Name): RHONDA BENNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 SOUTH FORTY DRIVE
ST. LOUIS MO
63141-8820
US

IV. Provider business mailing address

2108 MEADOW OAKS LN
WASHINGTON MO
63090-4132
US

V. Phone/Fax

Practice location:
  • Phone: 314-692-7172
  • Fax: 314-692-8544
Mailing address:
  • Phone: 636-239-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: