Provider Demographics
NPI:1508464223
Name:ROUSTIO, KATHRYN ANNE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:ROUSTIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 CRAIGSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4036
Mailing Address - Country:US
Mailing Address - Phone:314-275-0506
Mailing Address - Fax:314-463-4937
Practice Address - Street 1:7674 PLUMMER BUSINESS DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-7604
Practice Address - Country:US
Practice Address - Phone:314-275-0506
Practice Address - Fax:314-463-4937
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst