Provider Demographics
NPI:1578691671
Name:REYES, JENICE CORCEGA (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JENICE
Middle Name:CORCEGA
Last Name:REYES
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 1:5726 N KENMORE AVE
Mailing Address - Street 2:#1S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4542
Mailing Address - Country:US
Mailing Address - Phone:773-275-5881
Mailing Address - Fax:
Practice Address - Street 1:3303 N OAKLEY AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6207
Practice Address - Country:US
Practice Address - Phone:312-781-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist