Individual
MISS JACQUELYN MARIE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. SLP
Contact information
Practice address
1049 E WILSON ST, SUITE 100, BATAVIA, IL 60510-2474
(630) 715-0199
Mailing address
1049 E WILSON ST, SUITE 100, BATAVIA, IL 60510-2474
(630) 715-0199
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242002313
IL
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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