Provider Demographics
NPI:1902090079
Name:VALLIER, JENNIFER L (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:VALLIER
Suffix:
Gender:F
Credentials:MA, 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 1:2159 W CHICAGO AVE
Mailing Address - Street 2:APT. 3R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5034
Mailing Address - Country:US
Mailing Address - Phone:816-769-3322
Mailing Address - Fax:
Practice Address - Street 1:2159 W CHICAGO AVE
Practice Address - Street 2:APT. 3R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5034
Practice Address - Country:US
Practice Address - Phone:816-769-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist