Individual
JACQUELINE MARIE TISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 WESTWOOD DR, MONTICELLO, IL 61856-8239
(217) 521-2571
Mailing address
15 WESTWOOD DR, MONTICELLO, IL 61856-8239
(217) 521-2571
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.012363
IL
Other
Enumeration date
06/26/2015
Last updated
06/26/2015
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