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General NPI Number Information
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NPI Number | 1083016190
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Entity Type | Individual
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Provider Name | JENNA BUDREAU PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 126 E JEFFERSON AVE 1E
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City | KIRKWOOD
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State | MO
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Zip | 63122-4005
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Country | US
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Telephone | 314-656-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 825 TOP NOTCH LN 1E
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City | EUREKA
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State | MO
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Zip | 63025-1046
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Country | US
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Telephone | 314-805-9286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 201303540
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License Number State | MO
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