Provider Demographics
NPI:1407298367
Name:LOY, JESSALYN ELAINE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSALYN
Middle Name:ELAINE
Last Name:LOY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MS
Other - First Name:JESSALYN
Other - Middle Name:ELAINE
Other - Last Name:LANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:600 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1906
Mailing Address - Country:US
Mailing Address - Phone:217-473-7225
Mailing Address - Fax:
Practice Address - Street 1:600 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1906
Practice Address - Country:US
Practice Address - Phone:217-473-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist