Individual
MRS. LAURA JEAN BODE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RT(T),CMD,B.S.
Contact information
Practice address
4921 PARK VIEW PLACE, ST LOUIS, MO 63110
(618) 210-1179
Mailing address
3610 FOSSIL CREEK LN, WATERLOO, IL 62298-4650
(618) 210-1179
Taxonomy
Speciality
Code
Description
License number
State
2471R0002X
Radiation Therapy Radiologic Technologist
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
11/16/2007
Last updated
11/16/2007
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