Individual
LISA L BLOODWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12555 PARTRIDGE RUN DR, FLORISSANT, MO 63033-5015
(314) 953-7600
Mailing address
15955 NEW HALLS FERRY RD, FLORISSANT, MO 63031-1298
(314) 953-4991
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0483029
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
465926707
—
MO
Enumeration date
04/13/2018
Last updated
04/13/2018
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