Provider Demographics
NPI:1376962332
Name:LAPORTE, JESSICA M (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:M
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S WA PELLA AVE
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3038
Mailing Address - Country:US
Mailing Address - Phone:847-392-6180
Mailing Address - Fax:847-392-6180
Practice Address - Street 1:2500 CABOT DR
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3607
Practice Address - Country:US
Practice Address - Phone:630-864-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12151107235Z00000X
IL146.011954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist