Provider Demographics
NPI:1184861734
Name:BUCKLEY, JENNIFER ANN (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:IL
Mailing Address - Zip Code:60184-0566
Mailing Address - Country:US
Mailing Address - Phone:952-956-2089
Mailing Address - Fax:
Practice Address - Street 1:4N681 MUNGER RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:IL
Practice Address - Zip Code:60184-2486
Practice Address - Country:US
Practice Address - Phone:630-588-8543
Practice Address - Fax:630-588-1985
Is Sole Proprietor?:No
Enumeration Date:2009-01-17
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001023235Z00000X
IL146.010028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist