Healthcare Provider Details

I. General information

NPI: 1538896774
Provider Name (Legal Business Name): SAMANTHA LYNN BRADEN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA LYNN REDMOND AUD

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 385A
SAINT LOUIS MO
63141-8214
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-5850
  • Fax:
Mailing address:
  • Phone: 314-251-5850
  • Fax: 314-251-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2022030617
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: