Provider Demographics
NPI:1003424649
Name:BUHS, JACLYN NICOLE
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:NICOLE
Last Name:BUHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:NICOLE
Other - Last Name:CURIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4842 BODE LN
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-6601
Mailing Address - Country:US
Mailing Address - Phone:708-699-9569
Mailing Address - Fax:
Practice Address - Street 1:300 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3503
Practice Address - Country:US
Practice Address - Phone:708-699-9569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
CASP30712235Z00000X
NMSLP7243235Z00000X
IL146.011764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist