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General NPI Number Information
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NPI Number | 1164334066
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Entity Type | Individual
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Provider Name | JESSENIA GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 4100 SCOVILLE AVE # 60402
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City | STICKNEY
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State | IL
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Zip | 60402-4428
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Country | US
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Telephone | 312-550-6392
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Fax |
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Provider Business Mailing Address
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Address Line | 2858 W HENDERSON ST UNIT B
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City | CHICAGO
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State | IL
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Zip | 60618-9604
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242.019011
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License Number State | IL
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