Provider Demographics
NPI:1932673415
Name:PICKERILL, TAMMY M
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
Last Name:PICKERILL
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 1:1800 STOREY LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:62018-1346
Mailing Address - Country:US
Mailing Address - Phone:618-462-1031
Mailing Address - Fax:618-462-1035
Practice Address - Street 1:1800 STOREY LN
Practice Address - Street 2:
Practice Address - City:COTTAGE HILLS
Practice Address - State:IL
Practice Address - Zip Code:62018-1346
Practice Address - Country:US
Practice Address - Phone:618-462-1031
Practice Address - Fax:618-462-1035
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist