Individual
MS. ALLISON JEAN MODGLIN,
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4921 PARKVIEW PL, STE 6A/6B/12A, SAINT LOUIS, MO 63110-1032
(314) 747-2500
(314) 747-2598
Mailing address
660 S EUCLID AVE, CB 8233, SAINT LOUIS, MO 63110-1010
(314) 747-2500
(314) 747-2598
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2011006238
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220024359
—
MO
05
—
ENROLLED
—
IL
Enumeration date
03/25/2011
Last updated
12/31/2019
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