Doctor Name: | MRS. KELLY RISHEILL GOSSRAU |
NPI Number: | 1093851974 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 107990 |
Business Practice Address: | 10560 Old Olive Street Rd Suite 100 Creve Coeur, MO - 631415916 |
Business Phone Number: | 3145674707 |
Business Fax Number: | 3145674505 |
Mailing Address: | 17057 Westridge Oaks Dr, GROVER |
State: | MO |
Postal Code: | 630401140 |
Phone Number: | 6364050127 |
Fax Number: | |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 107990 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |