Provider Demographics
NPI:1013562362
Name:IJEI, NGOZI (SLP)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:
Last Name:IJEI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16375 PIERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1600
Mailing Address - Country:US
Mailing Address - Phone:636-405-2701
Mailing Address - Fax:636-422-1223
Practice Address - Street 1:16375 PIERSIDE LN
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1600
Practice Address - Country:US
Practice Address - Phone:636-405-2701
Practice Address - Fax:636-422-1223
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019029976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist