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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