Basic Information
| Provider Information | |||||||||
| NPI: | 1255696035 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEGAL | ||||||||
| FirstName: | EMILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1109 MOORLANDS DR | ||||||||
| Address2: | APT. A | ||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143634547 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3625 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631104048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147712990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 07/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2012001751 | MO | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.