Provider Demographics
NPI:1952434243
Name:JAGASIA, THERESA BETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:BETH
Last Name:JAGASIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 N FAIRFIELD AVE APT 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7850
Mailing Address - Country:US
Mailing Address - Phone:312-505-6725
Mailing Address - Fax:425-977-1077
Practice Address - Street 1:2901 N FAIRFIELD AVE APT 3S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7850
Practice Address - Country:US
Practice Address - Phone:312-505-6725
Practice Address - Fax:425-977-1077
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist