| Organization Name: | JENNIFER M MAUCK DBA BLOOM INTO SPEECH |
| NPI Number: | 1730318668 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KARIN RICHTER (BILLING SERVICE) |
| Mailing Address: | 164 N Myrtle Ave Elmhurst |
| State: | IL US |
| Postal Code: | 601262625 |
| Phone Number: | 7737712386 |
| Fax Number: | 6302790357 |
| NPI Enumeration Date: | 07/13/2009 |
| NPI Last Update Date: | 07/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 146006465 |
| 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 |