Individual
MRS. JEANNA R ANTRIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
2411 PATHWAYS XING, BELLEVILLE, IL 62221-5885
(618) 355-4756
Mailing address
1008 CHANCELLOR DR, EDWARDSVILLE, IL 62025-3904
(217) 821-3571
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.011139
IL
235Z00000X
Speech-Language Pathologist
2012038579
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146.011139
—
IL
Enumeration date
12/02/2013
Last updated
12/02/2013
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