Licis, Amy Kathleen
Licis, Amy Kathleen is an individual health care provider with primary practice located at 1600 S Brentwood Blvd Div Neurology Sleep Med, Ste 600, Saint Louis MO 63144-1320. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sleep Medicine, Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is her primary health care specialty. Licis, Amy Kathleen can be contacted via phone (314) 362-1408.Contact Information
Primary practice address
1600 S Brentwood Blvd Div Neurology Sleep Med, Ste 600
Saint Louis MO 63144-1320
Phone: (314) 362-1408
Fax: (314) 747-4342
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Sleep Medicine | 2080S0012X | 2009014878 | Missouri |
| Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology | 2084N0402X | 2009014878 | Missouri |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 2009014878 | Missouri |
Profile Details
| NPI number | 1992914352 |
|---|---|
| LBN Legal business name | Licis, Amy Kathleen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 22nd, 2007 |
| Last updated | Apr 25th, 2024 - about 8 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992914352 | NPPES |
| Missouri | MEDICAID | 204515803 |
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