Provider Demographics
NPI:1427699172
Name:WEBBER, JESSICA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WEBBER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:IL
Mailing Address - Zip Code:61873-9301
Mailing Address - Country:US
Mailing Address - Phone:785-236-0835
Mailing Address - Fax:866-806-1090
Practice Address - Street 1:708 E WOODLAND DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:IL
Practice Address - Zip Code:61873-9301
Practice Address - Country:US
Practice Address - Phone:785-236-0835
Practice Address - Fax:866-806-1090
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13819235Z00000X
IL146.015585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13819OtherLICENSE
IL146.015585OtherIDFPR