Provider Demographics
NPI:1215056395
Name:GRZYBEK, JENNIFER (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GRZYBEK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5065 W PENSACOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1457
Mailing Address - Country:US
Mailing Address - Phone:773-383-4184
Mailing Address - Fax:
Practice Address - Street 1:4801 W PETERSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5726
Practice Address - Country:US
Practice Address - Phone:773-202-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist