MEDICARE: MRS. RAIZL MAYER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2009001292	MO

General Provider Information

NPI Number	:	1215249610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAIZL MAYER

Provider Business Mailing Address
First Line	:	8340 BALSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-5036
Country	:	US
Telephone Number	:	314-534-9695
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 S BIG BEND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-2206
Country	:	US
Telephone Number	:	314-534-9695
Fax Number	:	314-735-4224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/14/2010

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Directions to “ MRS. RAIZL MAYER ” Practice Location

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