Individual
KELLY MOFFATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4055 LACLEDE AVE APT 312, SAINT LOUIS, MO 63108-3255
(314) 324-6792
Mailing address
4055 LACLEDE AVE APT 312, SAINT LOUIS, MO 63108-3255
(314) 324-6792
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
20130011673
MO
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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