Provider Demographics
NPI:1447422704
Name:JEPPSON, LAURIE SUE (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:SUE
Last Name:JEPPSON
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2994 E 2370TH RD
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341-9302
Mailing Address - Country:US
Mailing Address - Phone:815-326-0534
Mailing Address - Fax:815-587-0880
Practice Address - Street 1:2994 E 2370TH RD
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-9302
Practice Address - Country:US
Practice Address - Phone:815-326-0534
Practice Address - Fax:815-587-0880
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist