Basic Information
| Provider Information | |||||||||
| NPI: | 1417252917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCFALLS | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5354 S FREEPORT RD | ||||||||
| Address2: | |||||||||
| City: | POLO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610649748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155906063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 ANCHOR RD | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610218829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152886691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2011 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 235Z00000X | 146008250 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.