Healthcare Provider Details

I. General information

NPI: 1457496267
Provider Name (Legal Business Name): JENNIFER MERTH MT-BC, NMT, DT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 S 1ST ST
PRINCETON IL
61356-2404
US

IV. Provider business mailing address

PO BOX 102
PRINCETON IL
61356-0102
US

V. Phone/Fax

Practice location:
  • Phone: 815-875-5848
  • Fax: 815-875-5848
Mailing address:
  • Phone: 815-875-5848
  • Fax: 815-875-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number01376
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberJM53230998P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: