Provider Demographics
NPI:1457559080
Name:GESSERT, EUGENE KELLY (AUD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KELLY
Last Name:GESSERT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WINDING STAIR WAY
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6125
Mailing Address - Country:US
Mailing Address - Phone:636-728-8840
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR STE 208A
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4773
Practice Address - Country:US
Practice Address - Phone:314-251-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100196231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO337455505Medicaid
MO223911825Medicare PIN