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Organization
KIPP ST. LOUIS
Active
Organization
KIPP ST. LOUIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIAN VIZITEI (MEDICAID CORDINATOR)
(573) 489-1662
Entity
Organization
Contact information
Practice address
2647 OHIO AVE, SAINT LOUIS, MO 63118-1533
(314) 349-1388
Mailing address
2647 OHIO AVE, SAINT LOUIS, MO 63118-1533
(314) 349-1388
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
251300000X
Local Education Agency (LEA)
Primary
—
NULL
Other
Enumeration date
11/25/2025
Last updated
11/25/2025
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