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NPI Code Detail

MEDICARE: JENNIFER JANE DUCKWORTH

MEDICARE:   JENNIFER JANE DUCKWORTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist146012121IL

General Provider Information

NPI Number : 1689087611
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER JANE DUCKWORTH
Provider Business Mailing Address
First Line : 917 LINCOLN RD
Second Line :
City : MARQUETTE HEIGHTS
State : IL
Zip : 61554-1345
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 917 LINCOLN RD
Second Line :
City : MARQUETTE HEIGHTS
State : IL
Zip : 61554-1345
Country : US
Telephone Number : 309-231-2772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2014
Last Update Date : 06/06/2014

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Directions to “ JENNIFER JANE DUCKWORTH ” Practice Location

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