# KIPP ST. LOUIS

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063374270
- **Authorized official:** JULIAN VIZITEI (MEDICAID CORDINATOR)
- **Authorized official phone:** (573) 489-1662

## Contact information

- **Practice address:** 2647 OHIO AVE, SAINT LOUIS, MO 63118-1533
- **Practice address phone:** (314) 349-1388
- **Mailing address:** 2647 OHIO AVE, SAINT LOUIS, MO 63118-1533
- **Mailing address phone:** (314) 349-1388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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) | — | NULL | Yes |

## Other

- **Enumeration date:** 11/25/2025
- **Last updated:** 11/25/2025