Healthcare Provider Details

I. General information

NPI: 1306752449
Provider Name (Legal Business Name): JAYDEN MICHAEL WESTBROOKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 LUCAS AND HUNT RD
SAINT LOUIS MO
63136-1408
US

IV. Provider business mailing address

1022 E RUE DE LA BANQUE APT D
CREVE COEUR MO
63141-5156
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-8070
  • Fax:
Mailing address:
  • Phone: 618-697-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026038801
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: