Organization
GRACE HILL NEIGHBORHOOD HEALTH CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LUCCA (LICENSED DIETITIAN)
(314) 814-8556
Entity
Organization
Contact information
Practice address
2220 LEMP AVE, SAINT LOUIS, MO 63104-2700
(314) 814-8556
(314) 814-8542
Mailing address
2220 LEMP AVE, SAINT LOUIS, MO 63104-2700
(314) 814-8556
(314) 814-8542
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
2009014930
MO
251300000X
Local Education Agency (LEA)
—
—
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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