Provider Demographics
NPI:1164556502
Name:SHEPARD, JANICE TUCKER (MS,CCC,SLP -L)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:TUCKER
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MS,CCC,SLP -L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 S HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5614
Mailing Address - Country:US
Mailing Address - Phone:773-445-1051
Mailing Address - Fax:773-779-1520
Practice Address - Street 1:9405 S HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5614
Practice Address - Country:US
Practice Address - Phone:773-445-1051
Practice Address - Fax:773-779-1520
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-0003191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist