Provider Demographics
NPI:1235443284
Name:STURGEON, TESSA (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:STURGEON
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 1:4220 N CLARK ST
Mailing Address - Street 2:2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1301
Mailing Address - Country:US
Mailing Address - Phone:502-494-7217
Mailing Address - Fax:
Practice Address - Street 1:4220 N CLARK ST
Practice Address - Street 2:2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1301
Practice Address - Country:US
Practice Address - Phone:502-494-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist