Healthcare Provider Details

I. General information

NPI: 1396152807
Provider Name (Legal Business Name): GATEWAY CENTER FOR THE ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 N HIGHWAY 47
UNION MO
63084-1495
US

IV. Provider business mailing address

1281 N HIGHWAY 47
UNION MO
63084-1495
US

V. Phone/Fax

Practice location:
  • Phone: 636-583-0788
  • Fax: 636-583-0921
Mailing address:
  • Phone: 636-583-0788
  • Fax: 636-583-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2013028552
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number114517
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2013028552
License Number StateMO

VIII. Authorized Official

Name: MS. KIMBERLY S HELM
Title or Position: EXECUTIVE DIRECTOR
Credential: MS,CCC-SLP,BCBA-LBA
Phone: 636-583-0788