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General NPI Number Information
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NPI Number | 1083487961
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Entity Type | Individual
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Provider Name | KAILA WALLACE DOULA
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Gender | Female
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 3407 S JEFFERSON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3119
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Country | US
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Telephone | 314-252-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 12685 DORSETT RD # 405
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2100
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Country | US
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Telephone | 314-252-1933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number | 1230241401
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License Number State | IL
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