Basic Information
| Provider Information | |||||||||
| NPI: | 1922640713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEL | ||||||||
| FirstName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 N BERKS ST | ||||||||
| Address2: | |||||||||
| City: | BOYERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195122109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4849411246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 COMPASS RD | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600268001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777873430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2019 | ||||||||
| LastUpdateDate: | 10/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL140662 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 30279512 | 01 | PA | DRIVERS LICENSE | OTHER |