Provider Demographics
NPI:1083016190
Name:BUDREAU, JENNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:BUDREAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 TOP NOTCH LN
Mailing Address - Street 2:1E
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1046
Mailing Address - Country:US
Mailing Address - Phone:314-805-9286
Mailing Address - Fax:
Practice Address - Street 1:126 E JEFFERSON AVE
Practice Address - Street 2:1E
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4005
Practice Address - Country:US
Practice Address - Phone:314-656-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201303540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist