Provider Demographics
NPI:1871878249
Name:RAGUSA, JENNIFER S (AUD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:RAGUSA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1600 S. 4TH
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550
Mailing Address - Country:US
Mailing Address - Phone:309-284-0164
Mailing Address - Fax:
Practice Address - Street 1:8600 N STATE ROUTE 91
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9541
Practice Address - Country:US
Practice Address - Phone:309-691-6616
Practice Address - Fax:309-691-2943
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001409231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist