Provider Demographics
NPI:1902182314
Name:ST. LOUIS PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:ST. LOUIS PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/ LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYMONTEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-EWING
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:314-867-0065
Mailing Address - Street 1:801 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8959 RIVERVIEW BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-1475
Practice Address - Country:US
Practice Address - Phone:314-867-0634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-30
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023675251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)