Individual
JENNIFER TILLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 NE 46TH ST, KANSAS CITY, MO 64116-2042
(816) 413-5107
Mailing address
2000 NE 46TH ST, KANSAS CITY, MO 64116-2042
(816) 413-5107
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2010003170
MO
Other
Enumeration date
11/30/2011
Last updated
11/30/2011
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