Provider Demographics
NPI:1255957197
Name:ABRAMS, JENNA MICHELE (AUD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELE
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9835 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1243
Mailing Address - Country:US
Mailing Address - Phone:314-968-4710
Mailing Address - Fax:314-968-4762
Practice Address - Street 1:9835 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1243
Practice Address - Country:US
Practice Address - Phone:314-968-4710
Practice Address - Fax:314-968-4762
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11799122-4101231H00000X
MO2020016774231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist