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General NPI Number Information
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NPI Number | 1821143272
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Entity Type | Individual
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Provider Name | KATHLEEN J BROCK PHD
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 1 BROOKINGS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63130-4862
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Country | US
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Telephone | 314-935-6666
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Fax | 314-935-8515
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Provider Business Mailing Address
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Address Line | 3157 GENTILLY BLVD # 6490
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City | NEW ORLEANS
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State | LA
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Zip | 70122-3872
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Country | US
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Telephone | 504-290-0134
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2006029891
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License Number State | MO
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