Provider Demographics
NPI:1740562651
Name:VATTEROTT-MORI, MADELEINE KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:KAY
Last Name:VATTEROTT-MORI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WELDON SPRING HEIGHTS DR.
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-5623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 WELDON SPRING HEIGHTS DR.
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-5623
Practice Address - Country:US
Practice Address - Phone:636-395-3460
Practice Address - Fax:636-244-3164
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01400103T00000X, 320900000X
MO2012029564103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst