Provider Demographics
NPI:1700036563
Name:RUDEWICZ, JACQUELINE ANNE (MSP CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANNE
Last Name:RUDEWICZ
Suffix:
Gender:F
Credentials:MSP CCC-SLP/L
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:ANNE
Other - Last Name:SEIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP CCC-SLP/L
Mailing Address - Street 1:434 W WELLINGTON AVE
Mailing Address - Street 2:APT. 308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5820
Mailing Address - Country:US
Mailing Address - Phone:352-665-0326
Mailing Address - Fax:
Practice Address - Street 1:434 W WELLINGTON AVE
Practice Address - Street 2:APT. 308
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5820
Practice Address - Country:US
Practice Address - Phone:352-665-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist