Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2013021231 | MO |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 2013021231 | MO |
NPI | 1053558932 |
---|---|
Provider Name | Dr. Colleen Coughlin Claassen |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 15/01/2021 |