Healthcare Provider Details

I. General information

NPI: 1376579748
Provider Name (Legal Business Name): JESSICA KNEAREM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W SOUTH 1ST ST
SHELBYVILLE IL
62565-2203
US

IV. Provider business mailing address

209 W SOUTH 1ST ST
SHELBYVILLE IL
62565-2203
US

V. Phone/Fax

Practice location:
  • Phone: 217-774-4843
  • Fax: 217-774-4843
Mailing address:
  • Phone: 217-774-4843
  • Fax: 217-774-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: