Healthcare Provider Details

I. General information

NPI: 1437389665
Provider Name (Legal Business Name): MOMENTS OF SERENITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HIGH ST SUITE 3
WASHINGTON MO
63090-4396
US

IV. Provider business mailing address

1380 HIGH ST SUITE 3
WASHINGTON MO
63090-4396
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-0047
  • Fax: 636-390-9424
Mailing address:
  • Phone: 636-390-0047
  • Fax: 636-390-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER MARIE GILDEHAUS-BALLEYDIER
Title or Position: OWNER
Credential: LMT
Phone: 636-390-0047