Provider Demographics
NPI:1215605795
Name:VOLKL, ELISE JESSICA (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:JESSICA
Last Name:VOLKL
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 N KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4007
Mailing Address - Country:US
Mailing Address - Phone:773-294-6127
Mailing Address - Fax:
Practice Address - Street 1:535 S ELM ST
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2187
Practice Address - Country:US
Practice Address - Phone:630-773-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist