Individual
NINA MARIE FENSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
110 VIRGIL ST, O FALLON, MO 63366-2637
(636) 272-1059
(636) 980-1946
Mailing address
110 VIRGIL ST, O FALLON, MO 63366-2637
(636) 272-1059
(636) 980-1946
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2010028293
MO
Other
Enumeration date
08/27/2010
Last updated
06/09/2011
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