Jennifer Cullen

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.006564 Issued in IL

Practice address

2608 Fieldstone Dr
Maryville, IL 62062-6433

Phone

(618) 363-9675

NPI assigned

Nov 3, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

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.

{
    "created_epoch": "1446508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446508800000",
    "number": "1669845392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 FIELDSTONE DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620626433",
            "telephone_number": "618-363-9675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 FIELDSTONE DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620626433",
            "telephone_number": "618-363-9675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-03",
        "last_updated": "2015-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.006564",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP 20740",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "0325431",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Dobbin Connor, M.D.
• Larry Copp, M.S., CADC
• Cornerstone Counseling, P.C.
• Counselors Associates
• Abigail Jacqueline Crabtree, PA
• Amber D Da Gama Rose, PT
• James Joseph Dalla Riva, M.D.
• Federico Morta David
• Kimberly M. David, OTR
• Sarah Raenel 'Nel' Daymon, MS, CCC-SLP

• Speech-Language Pathologist in Maryville, IL
• Providers in Maryville, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; 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.