Provider Demographics
NPI:1275173825
Name:HERNANDEZ, JASMINE LUZ (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:LUZ
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 N PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2319
Mailing Address - Country:US
Mailing Address - Phone:773-512-4360
Mailing Address - Fax:
Practice Address - Street 1:1035 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4449
Practice Address - Country:US
Practice Address - Phone:708-848-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2021-03-10
Deactivation Date:2020-05-27
Deactivation Code:
Reactivation Date:2021-03-10
Provider Licenses
StateLicense IDTaxonomies
IL242.005174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist