Provider Demographics
NPI:1164680419
Name:ACEVEDO, JENNIFER L (MS CCC-SLP/L)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MS 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 1:8525 W CATHERINE AVE
Mailing Address - Street 2:UNIT 373
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2920
Mailing Address - Country:US
Mailing Address - Phone:773-399-0384
Mailing Address - Fax:
Practice Address - Street 1:3 ERIE CT
Practice Address - Street 2:SUITE 6120
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2519
Practice Address - Country:US
Practice Address - Phone:708-763-1320
Practice Address - Fax:708-763-1304
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist