Doctor Name: | JENNA PASSOLT |
NPI Number: | 1073827473 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. SLP |
License Number: | 242.001576 |
Business Practice Address: | 660 N Westmoreland Rd Lake Forest, IL - 600451659 |
Business Phone Number: | 8475356114 |
Business Fax Number: | 8475357847 |
Mailing Address: | 660 N Westmoreland Rd, LAKE FOREST |
State: | IL |
Postal Code: | 600451659 |
Phone Number: | 8475356114 |
Fax Number: | 8475357847 |
NPI Enumeration Date: | 07/28/2010 |
NPI Last Update Date: | 07/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 242.001576 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |