Healthcare Provider Details

I. General information

NPI: 1609724798
Provider Name (Legal Business Name): HAJAR ISMAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 S GRAND BLVD FL 1
SAINT LOUIS MO
63104-1540
US

IV. Provider business mailing address

1225 SW 1ST AVE APT 313
GAINESVILLE FL
32601-6173
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: