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Organization
NEUROTHERAPY CENTER OF ST LOUIS LLC
Active
Organization
NEUROTHERAPY CENTER OF ST LOUIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ASHLEY JOE WIEGAND M.S., LMFT, BCN (NEUROTHERAPIST)
(309) 369-8832
Entity
Organization
Contact information
Practice address
425 MARSHALL AVE, WEBSTER GRVS, MO 63119-1833
(636) 556-0873
Mailing address
2834 HAMPTON AVE, SAINT LOUIS, MO 63139-2627
(636) 556-0873
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
2013031915
MO
246ZE0500X
EEG Specialist/Technologist
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
12/17/2014
Last updated
12/30/2014
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