Most Relevant Information
Provider Data
| NPI Number: | 1003690207 |
| Provider Name: | LILY BLACK |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 2023034137 |
Most Important Dates
| Enumeration Date: | 08/21/2023 |
| Last Updated: | 08/21/2023 |
Provider Practice Location
10911 TESSON FERRY RD
SAINT LOUIS
MO
631236114
Practice Location Phone/Fax
| Phone: | 3147292485 |
| Fax: |
Provider Mailing Location
401 MEDINA DR
SAINT LOUIS
MO
631221427
Provider Mailing Phone/Fax
| Phone: | 3148252232 |
| Fax: |