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General NPI Number Information
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NPI Number | 1114170115
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Entity Type | Individual
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Provider Name | CHRISTINE LOUISE JAKUBEC M.A., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 1170 E BELVIDERE RD SUITE 204
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2061
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Country | US
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Telephone | 847-231-5500
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Fax | 847-231-5966
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Provider Business Mailing Address
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Address Line | 22621 N LINDEN DR
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City | LAKE BARRINGTON
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State | IL
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Zip | 60010-2337
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Country | US
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Telephone | 847-382-4647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147000290
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License Number State | IL
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