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Individual

JACKIE NICOLE ANDERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1793 W MOTEL RD, SYCAMORE, IL 60178-8673
(815) 501-1187
Mailing address
1793 W MOTEL RD, SYCAMORE, IL 60178-8673

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242005890
IL

Other

Enumeration date
05/13/2021
Last updated
05/13/2021
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