Individual
ALISON BROOKE THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
614 E ADAMS ST, JACKSON, MO 63755-2150
(573) 243-9513
Mailing address
12110 CLAYTON RD, SAINT LOUIS, MO 63131-2516
(314) 989-8150
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2020029626
MO
Other
Enumeration date
09/21/2020
Last updated
10/22/2021
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