Provider Demographics
NPI:1477359982
Name:PFEIFFER, OLIVER WRIGLEY
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:WRIGLEY
Last Name:PFEIFFER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LASALLE ST APT 429
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2770
Mailing Address - Country:US
Mailing Address - Phone:618-910-2483
Mailing Address - Fax:
Practice Address - Street 1:3033 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1632
Practice Address - Country:US
Practice Address - Phone:314-385-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO843120103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool