Provider Demographics
NPI:1154997617
Name:TEAMAN, JENA ELYCE (MS)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:ELYCE
Last Name:TEAMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:ELYCE
Other - Last Name:PINCHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1211 FERNLEAF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1421
Mailing Address - Country:US
Mailing Address - Phone:330-401-4905
Mailing Address - Fax:
Practice Address - Street 1:10332 OLD OLIVE STREET RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5922
Practice Address - Country:US
Practice Address - Phone:314-567-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021018665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist