Provider Demographics
NPI:1245427475
Name:WEISSMUELLER, JACQUELINE J (MS CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:WEISSMUELLER
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 1:14425 S. KILDARE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445
Mailing Address - Country:US
Mailing Address - Phone:708-309-5459
Mailing Address - Fax:708-597-5422
Practice Address - Street 1:14425 KILDARE AVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2649
Practice Address - Country:US
Practice Address - Phone:708-309-5459
Practice Address - Fax:708-597-5422
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-009080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632676OtherBLUE CROSS/BLUE SHIELD