Jeanna Richelle Olivero

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.006286 Issued in IL

Practice address

140 Mary Senica CT
La Salle, IL 61301-9658

Phone

(815) 579-7799

NPI assigned

Dec 16, 2018

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 16, 2018.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544918400000",
    "number": "1306317656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 MARY SENICA CT",
            "city": "LA SALLE",
            "state": "IL",
            "postal_code": "613019658",
            "telephone_number": "815-579-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 MARY SENICA CT",
            "city": "LA SALLE",
            "state": "IL",
            "postal_code": "613019658",
            "telephone_number": "815-579-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVERO",
        "first_name": "JEANNA",
        "middle_name": "RICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.006286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in La Salle, IL
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.