Provider Demographics
NPI:1437296134
Name:MEHRLE, ELIZABETH SQUIBB
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SQUIBB
Last Name:MEHRLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SQUIBB
Other - Last Name:PURICELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 OLD MILL PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6550
Mailing Address - Country:US
Mailing Address - Phone:636-926-2700
Mailing Address - Fax:636-447-4919
Practice Address - Street 1:4140 OLD MILL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6550
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:636-447-4919
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004017837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist