Healthcare Provider Details

I. General information

NPI: 1518024918
Provider Name (Legal Business Name): ANGELA MICHELE GILLENTINE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 OLD DES PERES RD
SAINT LOUIS MO
63131-1865
US

IV. Provider business mailing address

3264 STATE HIGHWAY 110
GRAND SALINE TX
75140-5098
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-0077
  • Fax: 314-729-0101
Mailing address:
  • Phone: 972-747-1333
  • Fax: 972-747-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2022039713
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number51020
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51020
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2022039713
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: