Provider Demographics
NPI:1588239651
Name:UNZICKER, JEANNE ANN
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
Last Name:UNZICKER
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 1:2332 E HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:CASEY
Mailing Address - State:IL
Mailing Address - Zip Code:62420-3204
Mailing Address - Country:US
Mailing Address - Phone:217-932-3869
Mailing Address - Fax:
Practice Address - Street 1:301 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:CASEY
Practice Address - State:IL
Practice Address - Zip Code:62420-1768
Practice Address - Country:US
Practice Address - Phone:217-932-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist