Provider Demographics
NPI:1144972514
Name:HURRELBRINK, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HURRELBRINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9539 US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:SAINT JACOB
Mailing Address - State:IL
Mailing Address - Zip Code:62281-1309
Mailing Address - Country:US
Mailing Address - Phone:618-667-5406
Mailing Address - Fax:
Practice Address - Street 1:9539 US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:SAINT JACOB
Practice Address - State:IL
Practice Address - Zip Code:62281-1309
Practice Address - Country:US
Practice Address - Phone:618-667-5406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242.006454OtherPROFESSIONAL LICENSE