Provider Demographics
NPI:1407972003
Name:PEARSON, JENNIFER MARIE (MS CCC SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MS CCC SLP-L
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:PAULUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP/L
Mailing Address - Street 1:2014 N SHEFFIELD AVE APT A3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4297
Mailing Address - Country:US
Mailing Address - Phone:773-857-1713
Mailing Address - Fax:
Practice Address - Street 1:2014 N SHEFFIELD AVE APT A3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4297
Practice Address - Country:US
Practice Address - Phone:773-857-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist