Provider Demographics
NPI:1023221058
Name:MAUCK, JENNIFER MARGARET (MS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARGARET
Last Name:MAUCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 N LAKEWOOD AVE
Mailing Address - Street 2:UNIT 3-SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3738
Mailing Address - Country:US
Mailing Address - Phone:773-771-2386
Mailing Address - Fax:773-262-2710
Practice Address - Street 1:6815 N LAKEWOOD AVE
Practice Address - Street 2:UNIT 3-SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3738
Practice Address - Country:US
Practice Address - Phone:773-771-2386
Practice Address - Fax:773-262-2710
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist