Healthcare Provider Details

I. General information

NPI: 1982917423
Provider Name (Legal Business Name): JENNIFER ORFUSS M.S., SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 N. LAKE SHORE DR. #613
CHICAGO IL
60610-5131
US

IV. Provider business mailing address

1350 N. LAKE SHORE DR. #613
CHICAGO IL
60610-5131
US

V. Phone/Fax

Practice location:
  • Phone: 312-640-5996
  • Fax: 312-640-5996
Mailing address:
  • Phone: 312-640-5996
  • Fax: 312-640-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.009148
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: