Individual
DR. AMY KATHLEEN LICIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 S BRENTWOOD BLVD, DIV NEUROLOGY SLEEP MED, STE 600, SAINT LOUIS, MO 63144-1320
(314) 362-1408
(314) 747-4342
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-1408
(314) 747-4342
Taxonomy
Speciality
Code
Description
License number
State
2080S0012X
Pediatric Sleep Medicine Physician
2009014878
MO
2084N0400X
Neurology Physician
Primary
2009014878
MO
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
2009014878
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204515803
—
MO
Enumeration date
05/22/2007
Last updated
04/17/2025
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