Provider Demographics
NPI:1215249610
Name:MAYER, RAIZL
Entity type:Individual
Prefix:MRS
First Name:RAIZL
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RAIZL
Other - Middle Name:
Other - Last Name:BRANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8340 BALSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-5036
Mailing Address - Country:US
Mailing Address - Phone:314-534-9695
Mailing Address - Fax:
Practice Address - Street 1:1524 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-2206
Practice Address - Country:US
Practice Address - Phone:314-534-9695
Practice Address - Fax:314-735-4224
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009001292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist