Provider Demographics
NPI:1568041648
Name:BRETTSCHNEIDER, JENNA ELISE (DPM)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ELISE
Last Name:BRETTSCHNEIDER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 7005
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-991-3668
Mailing Address - Fax:314-991-3665
Practice Address - Street 1:621 S NEW BALLAS RD STE 7005
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-991-3668
Practice Address - Fax:313-343-3401
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024017623213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery