Individual
MARY INSALACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSE DIETITIAN
Contact information
Practice address
3115 WYNFIELD TERRACE CT, SAINT LOUIS, MO 63129-3971
(314) 695-0797
Mailing address
2220 LEMP AVE, SAINT LOUIS, MO 63104-2700
(314) 814-8615
(314) 814-8542
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
2009014930
MO
133V00000X
Registered Dietitian
Primary
2009014930
MO
Other
Enumeration date
09/16/2009
Last updated
04/07/2026
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