Healthcare Provider Details

I. General information

NPI: 1033009550
Provider Name (Legal Business Name): JENNA BRONSTRUP AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16761 SOUTHPARK CTR
STRONGSVILLE OH
44136-9302
US

IV. Provider business mailing address

1204 CORSHAM CIR
AKRON OH
44312-5908
US

V. Phone/Fax

Practice location:
  • Phone: 440-878-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02586
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: