Individual
LILY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10911 TESSON FERRY RD, SAINT LOUIS, MO 63123-6114
(314) 729-2485
Mailing address
401 MEDINA DR, SAINT LOUIS, MO 63122-1427
(314) 825-2232
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2023034137
MO
Other
Enumeration date
08/21/2023
Last updated
08/21/2023
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