Provider Demographics
NPI:1881996486
Name:GILFILLAN-JONES, TESSA (MS CCC-A)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:GILFILLAN-JONES
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1982
Mailing Address - Country:US
Mailing Address - Phone:309-263-7545
Mailing Address - Fax:
Practice Address - Street 1:320 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1982
Practice Address - Country:US
Practice Address - Phone:309-263-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001142231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
147.001142OtherIL DEPARTMENT OF PROFFESSIONAL REGULATION