Provider Demographics
NPI:1164015251
Name:SLIFER, JANE LYN
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LYN
Last Name:SLIFER
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 1:205 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:IL
Mailing Address - Zip Code:61732-9087
Mailing Address - Country:US
Mailing Address - Phone:309-963-4514
Mailing Address - Fax:
Practice Address - Street 1:OLYMPIA NORTH ELEMENTARY SCHOOL
Practice Address - Street 2:205 N STATE STREET
Practice Address - City:DANVERS
Practice Address - State:IL
Practice Address - Zip Code:61732-6173
Practice Address - Country:US
Practice Address - Phone:309-963-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist