MEDICARE: CHILDGARDEN CHILD DEVELOPMENT CENTER

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	001564507	MO

General Provider Information

NPI Number	:	1467894261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDGARDEN CHILD DEVELOPMENT CENTER

Provider Business Mailing Address
First Line	:	4150 LACLEDE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2813
Country	:	US
Telephone Number	:	314-531-8148
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 LACLEDE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2813
Country	:	US
Telephone Number	:	314-531-8148
Fax Number	:

Authorized Official
Title or Position	:	CENTER DIRECTOR
Name	:	CHRIS KLOEPPEL
Credential	:	M.A. NPA
Telephone Number	:	314-531-8148

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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Directions to “CHILDGARDEN CHILD DEVELOPMENT CENTER ” Practice Location

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