Healthcare Provider Details

I. General information

NPI: 1851621296
Provider Name (Legal Business Name): JENNIFER ROSE MATHEWS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 CLAYTON RD SUITE 136
SAINT LOUIS MO
63124-1685
US

IV. Provider business mailing address

9890 CLAYTON RD SUITE 136
SAINT LOUIS MO
63124-1685
US

V. Phone/Fax

Practice location:
  • Phone: 314-222-5872
  • Fax: 314-222-5873
Mailing address:
  • Phone: 314-222-5872
  • Fax: 314-222-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2009015463
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2009015463
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3977
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: