Individual
KATHLEEN MARTHA NIEBRUGGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
373 S WILLOW ST # 110, MANCHESTER, NH 03103-5751
(314) 888-5233
Mailing address
4061 LINMORE DR, SAINT LOUIS, MO 63129-2041
(314) 359-5812
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
116963
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116963
LICESNSE
MO
Enumeration date
03/06/2019
Last updated
03/06/2019
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