Provider Demographics
NPI:1003458761
Name:EISENBEIS, JAMIE (MHS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:EISENBEIS
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, CCC-SLP
Mailing Address - Street 1:6038 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3115 S GRAND BLVD STE 224
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1047
Practice Address - Country:US
Practice Address - Phone:314-312-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017030048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty