Provider Demographics
NPI:1609223221
Name:CLANCY, JENA L (DPT)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:L
Last Name:CLANCY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:L
Other - Last Name:PARISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:1300 VETERANS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2394
Practice Address - Country:US
Practice Address - Phone:636-931-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist