Individual
ANGELA MICHELE GILLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
1010 OLD DES PERES RD, SAINT LOUIS, MO 63131-1865
(314) 729-0077
(314) 729-0101
Mailing address
3264 STATE HIGHWAY 110, GRAND SALINE, TX 75140-5098
(972) 747-1333
(972) 747-1132
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2022039713
MO
231H00000X
Audiologist
51020
TX
237600000X
Audiologist-Hearing Aid Fitter
2022039713
MO
237600000X
Audiologist-Hearing Aid Fitter
51020
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1469165-04
—
TX
01
—
33-1023289
FEDERAL TAX ID
TX
01
—
331023289
UNITED HEALTH CARE
—
01
—
430835090
TAX ID
MO
01
—
528407
BLUECROSS AND BLUESHIELD
TX
01
—
7065317
AETNA
TX
Enumeration date
01/03/2007
Last updated
06/30/2026
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