Provider Demographics
NPI:1568667665
Name:ST. JOSEPH INSTITUTE FOR THE DEAF
Entity Type:Organization
Organization Name:ST. JOSEPH INSTITUTE FOR THE DEAF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROEKELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-532-3211
Mailing Address - Street 1:1314 STRASSNER
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1314 STRASSNER
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:636-532-3211
Practice Address - Fax:636-532-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO231H00000X, 235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100408120AMedicaid
MO107551OtherBLUE CROSSBLUE SHIELD MO
KS26919011OtherBLUECROSS BLUE SHIELD
MO107551OtherBLUE CROSSBLUE SHIELD MO
KS100408120AMedicaid