MEDICARE: JENNIFER MEGANN ERICKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	242.005388	IL

General Provider Information

NPI Number	:	1619523396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MEGANN ERICKSON

Provider Business Mailing Address
First Line	:	1318 W 6TH ST
Second Line	:
City	:	KEWANEE
State	:	IL
Zip	:	61443-1261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S WEST ST
Second Line	:
City	:	CAMBRIDGE
State	:	IL
Zip	:	61238-1430
Country	:	US
Telephone Number	:	309-937-2028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2019
Last Update Date	:	08/17/2019

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Directions to “ JENNIFER MEGANN ERICKSON ” Practice Location

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