Individual
ELLEN LAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1 COLLEGE PARK DR, SAINT LOUIS, MO 63141-8660
(920) 619-9466
Mailing address
1 COLLEGE PARK DR, SAINT LOUIS, MO 63141-8660
(920) 619-9466
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/13/2016
Last updated
01/11/2024
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