Provider Demographics
NPI:1730351982
Name:KING, JOY NANETTE (CCC/SLP/L)
Entity type:Individual
Prefix:MISS
First Name:JOY
Middle Name:NANETTE
Last Name:KING
Suffix:
Gender:F
Credentials:CCC/SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BUCHANAN
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681
Mailing Address - Country:US
Mailing Address - Phone:217-322-4311
Mailing Address - Fax:
Practice Address - Street 1:1 BADER ALY
Practice Address - Street 2:
Practice Address - City:MEREDOSIA
Practice Address - State:IL
Practice Address - Zip Code:62665-7200
Practice Address - Country:US
Practice Address - Phone:217-584-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist