Provider Demographics
NPI:1851301683
Name:SANGSTON, JENNIFER LYNNE (MSCCCA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:SANGSTON
Suffix:
Gender:F
Credentials:MSCCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1715 N DIVISION STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450
Mailing Address - Country:US
Mailing Address - Phone:815-941-0400
Mailing Address - Fax:815-941-0400
Practice Address - Street 1:1715 N DIVISION STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450
Practice Address - Country:US
Practice Address - Phone:815-941-0400
Practice Address - Fax:815-941-0400
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter