Provider Demographics
NPI:1609328996
Name:LAGARCE, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LAGARCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:SCHUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4729 TIEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-5816
Mailing Address - Country:US
Mailing Address - Phone:636-346-7504
Mailing Address - Fax:
Practice Address - Street 1:801 N. 11TH STREET
Practice Address - Street 2:ST. LOUIS PUBLIC SCHOOLS
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107
Practice Address - Country:US
Practice Address - Phone:314-231-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor