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General NPI Number Information
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NPI Number | 1902182314
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Entity Type | Organization
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Legal Business Name | ST. LOUIS PUBLIC SCHOOLS
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Dates
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Enumeration Date | 10/30/2011
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 8959 RIVERVIEW BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63147-1475
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Country | US
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Telephone | 314-867-0634
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Fax |
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Provider Business Mailing Address
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Address Line | 801 N 11TH ST
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City | SAINT LOUIS
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State | MO
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Zip | 63101-1015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH/ LANGUAGE PATHOLOGIST
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Name | MS. RAYMONTEZ JACKSON-EWING
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Credential | M.S. CCC-SLP
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Telephone | 314-867-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 2011023675
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License Number State | MO
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