Provider Demographics
NPI:1548484637
Name:COX, CONSTANCE RENEE (SLP)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:RENEE
Last Name:COX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 GREENHOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-1610
Mailing Address - Country:US
Mailing Address - Phone:314-832-1823
Mailing Address - Fax:
Practice Address - Street 1:100 WOODLAND MNR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2030
Practice Address - Country:US
Practice Address - Phone:636-296-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004009992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist