Healthcare Provider Details

I. General information

NPI: 1639207533
Provider Name (Legal Business Name): MS. JEAN TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 FARRAGUT DR
SPRINGFIELD IL
62704-1433
US

IV. Provider business mailing address

2534 FARRAGUT DR
SPRINGFIELD IL
62704-1433
US

V. Phone/Fax

Practice location:
  • Phone: 217-726-6101
  • Fax: 217-726-6103
Mailing address:
  • Phone: 217-726-6101
  • Fax: 217-726-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: