Provider Demographics
NPI:1912041559
Name:SIREK JONES, ANNETTE ZOE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:ZOE
Last Name:SIREK JONES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:ZOE
Other - Last Name:TESLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61266-0067
Mailing Address - Country:US
Mailing Address - Phone:309-230-0779
Mailing Address - Fax:309-764-0533
Practice Address - Street 1:508 24TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4627
Practice Address - Country:US
Practice Address - Phone:309-230-0779
Practice Address - Fax:309-764-0533
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-005737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist