Jenna Bivens
Individual provider Active NPI Speech-Language Pathologist · Dupo, IL
NPI 1831864321 · NPPES record last updated Aug 16, 2021
Key facts
- NPI
- 1831864321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 905 Bluffview Elementary LN
Dupo, IL 62239-1544 - Phone
- (618) 286-3311
- NPI assigned
- Aug 16, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Yes |
Addresses
Primary practice location
905 Bluffview Elementary LN
Dupo, IL 62239-1544
Mailing address
781 Lake Lucille Dr
Waterloo, IL 62298-3233
Other providers in Dupo, IL
- Marcel Acris
- Affordable Dental of Illinois
- Affordable Dentistry of Il LLC
- Allison Benware
- Michael Z Bialas
- Community Unit School District No 196
- Michael Robert Dambacher
- Kimberly Davis
- Nicholas Michael Dubina
- Dupo Fire Protection District
All providers in Dupo, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.