Provider Demographics
NPI:1831720655
Name:BEINDORFF, MARY ELLEN (RD)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:BEINDORFF
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-2080
Mailing Address - Fax:314-286-2085
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV IM GERIATRIC MED, STE 330
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-286-2080
Practice Address - Fax:314-286-2085
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000173451133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO350081608Medicaid