MEDICARE: MS. SHONTA LATRICE MCLEMORE DOULA

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	374J00000X	Doula		MO

General Provider Information

NPI Number	:	1720846645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHONTA LATRICE MCLEMORE DOULA

Provider Business Mailing Address
First Line	:	3727 OAKMOUNT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4841
Country	:	US
Telephone Number	:	314-546-7267
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 OAKMOUNT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4841
Country	:	US
Telephone Number	:	314-546-7267
Fax Number	:

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

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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