Healthcare Provider Details

I. General information

NPI: 1992649347
Provider Name (Legal Business Name): JESSICA GLUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S NEW BALLAS RD
SAINT LOUIS MO
63141-8222
US

IV. Provider business mailing address

122 STONEYSIDE LN
OLIVETTE MO
63132-4124
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number246.001034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: