Provider Demographics
NPI:1023263084
Name:KESSLER-SANTICCIOLI, JACQUELINE (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:KESSLER-SANTICCIOLI
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 1:725 APPLE TREE LANE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022
Mailing Address - Country:US
Mailing Address - Phone:847-786-4212
Mailing Address - Fax:
Practice Address - Street 1:725 APPLE TREE LANE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022
Practice Address - Country:US
Practice Address - Phone:847-786-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010116235Z00000X
NY008496-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist