Provider Demographics
NPI:1659598811
Name:MILLS, JENNIFER WELCH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:WELCH
Last Name:MILLS
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 1:1572 MAPLE AVE
Mailing Address - Street 2:UNIT 504
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4328
Mailing Address - Country:US
Mailing Address - Phone:847-491-9249
Mailing Address - Fax:
Practice Address - Street 1:1572 MAPLE AVE
Practice Address - Street 2:UNIT 504
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4328
Practice Address - Country:US
Practice Address - Phone:847-491-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist