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General NPI Number Information
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NPI Number | 1295691939
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Entity Type | Individual
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Provider Name | AUSTIN COOLBAUGH
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Gender | Male
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Dates
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Enumeration Date | 12/26/2025
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 1430 WASHINGTON AVE SUITE 229, ST. LOUIS, MO 63103
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City | ST LOUIS
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State | MO
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Zip | 63103
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Country | US
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Telephone | 314-970-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 5713 N BELT W
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City | BELLEVILLE
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State | IL
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Zip | 62226-4615
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Country | US
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Telephone | 314-970-5755
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | MO
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