=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871750562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEAF INTER-LINK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ST FRANCOIS SUITE 206
-----------------------------------------------------
City | FLORISSANTM
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63031-0510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-837-7757
-----------------------------------------------------
Fax | 314-837-0777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 510
-----------------------------------------------------
City | FLORISSANT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63032-0510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-837-7757
-----------------------------------------------------
Fax | 314-837-0777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ASSISTANT
-----------------------------------------------------
Name | MRS. JANNAI RENAE WADE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-837-7757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | LC7017310
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------