Healthcare Provider Details

I. General information

NPI: 1255957197
Provider Name (Legal Business Name): JENNA MICHELE ABRAMS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 WILNER DR
SAINT LOUIS MO
63130-3633
US

IV. Provider business mailing address

9835 MANCHESTER RD
SAINT LOUIS MO
63119-1243
US

V. Phone/Fax

Practice location:
  • Phone: 847-702-9105
  • Fax:
Mailing address:
  • Phone: 314-968-4710
  • Fax: 314-968-4762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2020016774
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: