Basic Information
Provider Information
NPI: 1730443979
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: O'GUIN
FirstName: NATALIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 49 BLACKTHORN DR
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631231001
CountryCode: US
TelephoneNumber: 3145186097
FaxNumber:  
Practice Location
Address1: 12110 CLAYTON RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631312516
CountryCode: US
TelephoneNumber: 3149898100
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/03/2012
LastUpdateDate: 04/03/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X2013022069MOY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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