Individual
MARY FANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 CHESTERTON LN, CHESTERFIELD, MO 63017-7837
(636) 207-9383
(636) 227-5533
Mailing address
5 CHESTERTON LN, CHESTERFIELD, MO 63017-7837
(636) 207-9383
(636) 227-5533
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
HE 00828
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6362275533
—
MO
Enumeration date
08/19/2016
Last updated
08/19/2016
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