Individual
JESSICA N VANDERWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CF-SLP
Contact information
Practice address
1925 S MAIN ST, BLOOMINGTON, IL 61704-7313
(515) 978-6755
Mailing address
707 GOLFCREST RD S APT 4, NORMAL, IL 61761-6044
(630) 890-9349
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242.005334
IL
Other
Enumeration date
06/18/2019
Last updated
06/18/2019
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