Provider Demographics
NPI:1073021408
Name:SCHACHELMAYER, JESSICA JANET (MA,CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JANET
Last Name:SCHACHELMAYER
Suffix:
Gender:F
Credentials:MA,CCC-SLP/L
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:JANET
Other - Last Name:GUNDRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP/L
Mailing Address - Street 1:466 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:VOLO
Mailing Address - State:IL
Mailing Address - Zip Code:60073-8182
Mailing Address - Country:US
Mailing Address - Phone:847-494-8563
Mailing Address - Fax:
Practice Address - Street 1:555 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1229
Practice Address - Country:US
Practice Address - Phone:847-526-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1831212091Medicaid