Provider Demographics
NPI:1275059784
Name:STOCKSTILL, JENNIFER (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STOCKSTILL
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:IL
Mailing Address - Zip Code:62069-1549
Mailing Address - Country:US
Mailing Address - Phone:217-999-4241
Mailing Address - Fax:
Practice Address - Street 1:804 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:IL
Practice Address - Zip Code:62069-1549
Practice Address - Country:US
Practice Address - Phone:217-999-4241
Practice Address - Fax:217-999-4241
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist