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General NPI Number Information
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NPI Number | 1558682534
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGY OF ST. LOUIS, LLC
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 9890 CLAYTON RD SUITE 136
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-222-5872
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Fax |
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Provider Business Mailing Address
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Address Line | 9890 CLAYTON RD SUITE 136
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-222-5872
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | DR. JENNIFER R MATHEWS
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Credential | PH.D.
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Telephone | 314-757-4969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2009015463
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License Number State | MO
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