Active NPI
Jenna Budreau, PSY.D.
- Psychologist
- Kirkwood, MO
National Provider Identifier
1083016190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 201303540
- Practice address
- 126 E Jefferson Ave
1E
Kirkwood, MO 63122-4005 - Phone
- (314) 656-8881
- NPI assigned
- Sep 19, 2014
- Last updated
- Sep 1, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 201303540 | MO | Primary |
Addresses
Primary practice location
126 E Jefferson Ave
1E
Kirkwood, MO 63122-4005
Mailing address
825 Top Notch LN
1E
Eureka, MO 63025-1046
Phone (314) 805-9286
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201303540 | MO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1083016190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 TOP NOTCH LN",
"address_2": "1E",
"city": "EUREKA",
"state": "MO",
"postal_code": "630251046",
"telephone_number": "314-805-9286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 E JEFFERSON AVE",
"address_2": "1E",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631224005",
"telephone_number": "314-656-8881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUDREAU",
"first_name": "JENNA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-19",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "201303540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.