Provider Demographics
NPI:1770582314
Name:HOBEN, JENNIFER L (SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:HOBEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:765 N KELLOGG ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2875
Mailing Address - Country:US
Mailing Address - Phone:309-343-3434
Mailing Address - Fax:309-343-3456
Practice Address - Street 1:765 N KELLOGG ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2875
Practice Address - Country:US
Practice Address - Phone:309-343-3434
Practice Address - Fax:309-343-3456
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146672Medicare ID - Type Unspecified