Provider Demographics
NPI:1265697437
Name:JEZIORO, ANN MARIE (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:JEZIORO
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:MISS
Other - First Name:ANN MARIE
Other - Middle Name:
Other - Last Name:DELACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP/L
Mailing Address - Street 1:1327 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4549
Mailing Address - Country:US
Mailing Address - Phone:630-552-3028
Mailing Address - Fax:
Practice Address - Street 1:4390 ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9866
Practice Address - Country:US
Practice Address - Phone:630-554-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist