Provider Demographics
NPI:1174967350
Name:STROTHKAMP, THERESA AILEEN (MED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:AILEEN
Last Name:STROTHKAMP
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:AILEEN
Other - Last Name:BROOKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1177 N WARSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1810
Mailing Address - Country:US
Mailing Address - Phone:314-569-2211
Mailing Address - Fax:314-569-0778
Practice Address - Street 1:1177 N WARSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1810
Practice Address - Country:US
Practice Address - Phone:314-569-2211
Practice Address - Fax:314-569-0778
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11211754103K00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11211754OtherLICENSE