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General NPI Number Information
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NPI Number | 1861743692
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Entity Type | Organization
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Legal Business Name | GREENTREE AUDIOLOGY INC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 10900 MANCHESTER RD STE 202
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City | KIRKWOOD
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State | MO
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Zip | 63122-1200
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Country | US
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Telephone | 314-835-9996
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Fax | 314-835-9992
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Provider Business Mailing Address
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Address Line | 10900 MANCHESTER RD STE 202
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City | KIRKWOOD
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State | MO
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Zip | 63122-1200
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Country | US
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Telephone | 314-835-9996
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Fax | 314-835-9992
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Authorized Official
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Title or Position | AUDIOLOGIST, OWNER
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Name | RUSSELL W PICKETT
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Credential | AUD,CCC-A/FAAA
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Telephone | 314-835-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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