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General NPI Number Information
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NPI Number | 1538835715
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Entity Type | Individual
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Provider Name | ABAGAIL ELIZABETH POELKER
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Gender | Female
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 395 W VETERANS MEMORIAL PKWY
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City | WARRENTON
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State | MO
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Zip | 63383-1066
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Country | US
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Telephone | 636-456-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 RIDGELAND CIR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-3536
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2021028852
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License Number State | MO
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