Provider Demographics
NPI:1699018689
Name:THOMAS, JESYKA E (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESYKA
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 S MARY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5739
Mailing Address - Country:US
Mailing Address - Phone:773-469-7890
Mailing Address - Fax:
Practice Address - Street 1:1424 E 53RD ST
Practice Address - Street 2:SUITE 307
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4500
Practice Address - Country:US
Practice Address - Phone:773-233-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist