Provider Demographics
NPI:1417433525
Name:PEARLSTEIN, JENNIFER GRACE (PHD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:GRACE
Last Name:PEARLSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-0202
Mailing Address - Fax:314-286-2675
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV ANES PAIN MGT, STE L40
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-747-0202
Practice Address - Fax:314-286-2675
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023036413103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490131664Medicaid