Individual
MARA LEAH HALICZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
114 LIBERTY PKWY APT A10, SAINT ROBERT, MO 65584-4875
(973) 508-9957
Mailing address
114 LIBERTY PKWY APT A10, SAINT ROBERT, MO 65584-4875
(973) 508-9957
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2022010152
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022010152
MISSOURI STATE BOARD - HEALING ARTS
MO
Enumeration date
07/02/2022
Last updated
07/02/2022
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