Provider Demographics
NPI:1871624510
Name:POPE, JANE ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANN
Last Name:POPE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4798 ANDREW RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-9301
Mailing Address - Country:US
Mailing Address - Phone:618-922-8870
Mailing Address - Fax:618-964-9038
Practice Address - Street 1:4798 ANDREW RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-9301
Practice Address - Country:US
Practice Address - Phone:618-922-8870
Practice Address - Fax:618-964-9038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
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