MEDICARE: JENNIFER GRZYBEK SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146008626	IL

General Provider Information

NPI Number	:	1215056395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GRZYBEK SLP

Provider Business Mailing Address
First Line	:	5065 W PENSACOLA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1457
Country	:	US
Telephone Number	:	773-383-4184
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 W PETERSON AVE STE 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5726
Country	:	US
Telephone Number	:	773-202-1616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	10/03/2017

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Directions to “ JENNIFER GRZYBEK SLP” Practice Location

Language	Start Address	Practice Location

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