Provider Demographics
NPI:1033885488
Name:DAMERALL, JEFFREY STUART
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STUART
Last Name:DAMERALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 TRAVELLA CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1547
Mailing Address - Country:US
Mailing Address - Phone:314-853-1910
Mailing Address - Fax:
Practice Address - Street 1:5910 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3407
Practice Address - Country:US
Practice Address - Phone:314-352-1043
Practice Address - Fax:314-352-3685
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020035169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist