Individual
JENNIFER REVELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3450 PHEASANT MEADOW DR, O FALLON, MO 63368-7324
(636) 379-0173
Mailing address
3450 PHEASANT MEADOW DR, O FALLON, MO 63368-7324
(636) 379-0173
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2021034984
MO
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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