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General NPI Number Information
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NPI Number | 1619692431
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Entity Type | Organization
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Legal Business Name | NICOLE WERNER CONSULTING LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 12747 OLIVE BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6269
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Country | US
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Telephone | 314-922-3871
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Fax | 314-529-3537
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Provider Business Mailing Address
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Address Line | 10 FENTON PLZ UNIT 60
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City | FENTON
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State | MO
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Zip | 63026-9993
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Country | US
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Telephone | 314-922-3871
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | NICOLE J WERNER
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Credential | PH.D.
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Telephone | 314-922-3871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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