Healthcare Provider Details

I. General information

NPI: 1205598935
Provider Name (Legal Business Name): JENNIFER L NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CORPORATE CENTRE DR
O FALLON MO
63368-8685
US

IV. Provider business mailing address

801 CORPORATE CENTRE DR
O FALLON MO
63368-8685
US

V. Phone/Fax

Practice location:
  • Phone: 636-851-4000
  • Fax:
Mailing address:
  • Phone: 636-851-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: