Provider Demographics
NPI:1477943389
Name:BERNSTEIN, JESSICA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MCCLURG CT
Mailing Address - Street 2:APT. 1411
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4323
Mailing Address - Country:US
Mailing Address - Phone:847-651-8510
Mailing Address - Fax:
Practice Address - Street 1:400 N MCCLURG CT
Practice Address - Street 2:APT. 1411
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4323
Practice Address - Country:US
Practice Address - Phone:847-651-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist