Individual
MARISA MATHUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 N 11TH ST, SAINT LOUIS, MO 63101-1015
(314) 776-7315
Mailing address
801 N 11TH ST, SAINT LOUIS, MO 63101-1015
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2012032512
MO
Other
Enumeration date
10/08/2012
Last updated
10/08/2012
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