Provider Demographics
NPI:1073902144
Name:WACKER, JESSICA I (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:WACKER
Suffix:I
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S MICHIGAN AVE UNIT 1308
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4203
Mailing Address - Country:US
Mailing Address - Phone:737-200-6467
Mailing Address - Fax:
Practice Address - Street 1:310 S MICHIGAN AVE
Practice Address - Street 2:1511
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4207
Practice Address - Country:US
Practice Address - Phone:908-377-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14043931OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION