Provider Demographics
NPI:1962717223
Name:DEGUENTZ, JENNIFER DEANN (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEANN
Last Name:DEGUENTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1817
Mailing Address - Country:US
Mailing Address - Phone:314-731-4555
Mailing Address - Fax:314-551-6105
Practice Address - Street 1:1 VILLAGE SQ STE A
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1817
Practice Address - Country:US
Practice Address - Phone:314-731-4555
Practice Address - Fax:314-551-6105
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist