Provider Demographics
NPI:1669846226
Name:SEIN, JACKELYN (MA CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:JACKELYN
Middle Name:
Last Name:SEIN
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6300
Mailing Address - Country:US
Mailing Address - Phone:773-318-6947
Mailing Address - Fax:
Practice Address - Street 1:3660 RESERVE DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-6300
Practice Address - Country:US
Practice Address - Phone:773-318-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist