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Individual

JENNIFER MICHELLE GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
SLP

Contact information

Practice address
212 VALE DR, FAIRVIEW HEIGHTS, IL 62208-2541
(314) 240-1553
Mailing address
212 VALE DR, FAIRVIEW HEIGHTS, IL 62208-2541
(314) 240-1553

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
146.007577
IL
235Z00000X
Speech-Language Pathologist
Primary
2013036904
MO

Other

Enumeration date
12/17/2013
Last updated
04/25/2023
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