Individual
CASEY VICKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1 CHILDRENS PL STE 3S34, SAINT LOUIS, MO 63110-1002
(314) 454-6006
Mailing address
1 CHILDRENS PL STE 3S34, SAINT LOUIS, MO 63110-1002
(314) 454-6120
(314) 454-4225
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2023040873
MO
Other
Enumeration date
06/27/2022
Last updated
07/16/2024
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