Provider Demographics
NPI:1801945720
Name:SATTERTHWAITE, JESSICA (MS, CCCSLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SATTERTHWAITE
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 385A
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-9794
Mailing Address - Country:US
Mailing Address - Phone:618-283-0118
Mailing Address - Fax:618-283-0118
Practice Address - Street 1:RR 1 BOX 385A
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-9794
Practice Address - Country:US
Practice Address - Phone:618-283-0118
Practice Address - Fax:618-283-0118
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist