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General NPI Number Information
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NPI Number | 1184508624
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Entity Type | Individual
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Provider Name | ELISABETH SHORT
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Gender | Female
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 7432 MARILLAC DR
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City | SAINT LOUIS
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State | MO
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Zip | 63121-4744
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Country | US
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Telephone | 314-495-8430
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Fax |
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Provider Business Mailing Address
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Address Line | 210 FIDDLECREEK RIDGE RD
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City | WENTZVILLE
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State | MO
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Zip | 63385-5726
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Country | US
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Telephone |
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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