Healthcare Provider Details

I. General information

NPI: 1295249357
Provider Name (Legal Business Name): JESSICA DUNCAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DELAURENTIS AUD

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 6180
APO AE
09604-6180
US

IV. Provider business mailing address

UNIT 6180
APO AE
09604-6180
US

V. Phone/Fax

Practice location:
  • Phone: 314-632-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004164
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: