Healthcare Provider Details

I. General information

NPI: 1669073243
Provider Name (Legal Business Name): TESS LEEANN SPENGLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S HOUSTON ST
TAYLORVILLE IL
62568-2073
US

IV. Provider business mailing address

600 S HOUSTON ST
TAYLORVILLE IL
62568-2073
US

V. Phone/Fax

Practice location:
  • Phone: 217-824-9636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: