Provider Demographics
NPI:1891068607
Name:AMES, CECILE DONQUE
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:DONQUE
Last Name:AMES
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 1:12047 TANGLETREE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4845
Mailing Address - Country:US
Mailing Address - Phone:314-599-6643
Mailing Address - Fax:
Practice Address - Street 1:12047 TANGLETREE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4845
Practice Address - Country:US
Practice Address - Phone:314-599-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108635OtherSTATE OF MISSOURI, MISSOURI BOARD OF HEALING ARTS