Healthcare Provider Details

I. General information

NPI: 1346160082
Provider Name (Legal Business Name): JESSICA MAY CARLYON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 WINDSOR DR
WHEATON IL
60189-8540
US

IV. Provider business mailing address

1313 WINDSOR DR
WHEATON IL
60189-8540
US

V. Phone/Fax

Practice location:
  • Phone: 732-278-3962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.018657
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: