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General NPI Number Information
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NPI Number | 1851015697
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Entity Type | Individual
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Provider Name | JESSICA RAE MARSHALL M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 2200 STATE ST
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439-1852
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Country | US
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Telephone | 618-240-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 205 W LINCOLN AVE
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City | CLAREMONT
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State | IL
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Zip | 62421-2531
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Country | US
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Telephone | 618-240-4555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146010359
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License Number State | IL
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