Provider Demographics
NPI:1659534972
Name:JELM, JUDY MICHELS
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MICHELS
Last Name:JELM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 5TH AVE
Mailing Address - Street 2:110
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3100
Mailing Address - Country:US
Mailing Address - Phone:630-983-6104
Mailing Address - Fax:
Practice Address - Street 1:200 E 5TH AVE
Practice Address - Street 2:110
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3100
Practice Address - Country:US
Practice Address - Phone:630-983-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist