Individual
JENNA BIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
905 BLUFFVIEW ELEMENTARY LN, DUPO, IL 62239-1544
(618) 286-3311
Mailing address
781 LAKE LUCILLE DR, WATERLOO, IL 62298-3233
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/16/2021
Last updated
08/16/2021
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