Organization
REVERE C-3 SCHOOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN HORNER (PRINCIPAL)
(660) 948-2621
Entity
Organization
Contact information
Practice address
ONE BULLDOG DRIVE, REVERE, MO 63465
(660) 948-2621
Mailing address
PO BOX 300, REVERE, MO 63465-0300
(660) 948-2621
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
114003
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506144906
—
MO
Enumeration date
05/12/2008
Last updated
05/12/2008
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