Provider Demographics
NPI:1588024921
Name:FERRELL, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FERRELL
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 1:3049 W MEDILL AVE
Mailing Address - Street 2:APT. 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4099
Mailing Address - Country:US
Mailing Address - Phone:573-382-0014
Mailing Address - Fax:
Practice Address - Street 1:3049 W MEDILL AVE
Practice Address - Street 2:APT. 1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4099
Practice Address - Country:US
Practice Address - Phone:573-382-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.003633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist