Provider Demographics
NPI:1023535762
Name:PERCY, JENNIFER D
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:PERCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S COAL ST
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62326-1209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 S COAL ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62326-1209
Practice Address - Country:US
Practice Address - Phone:309-776-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist