Provider Demographics
NPI:1962658435
Name:SPEER, JENNIFER LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SPEER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 DON DR
Mailing Address - Street 2:
Mailing Address - City:PECATONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61063-9582
Mailing Address - Country:US
Mailing Address - Phone:815-543-5612
Mailing Address - Fax:
Practice Address - Street 1:11475 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1285
Practice Address - Country:US
Practice Address - Phone:815-543-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003269363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical