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General NPI Number Information
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NPI Number | 1336626316
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Entity Type | Organization
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Legal Business Name | THE LOOP SPEECH, LANGUAGE, AND LEARNING
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 310 S MICHIGAN AVE UNIT 1308
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City | CHICAGO
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State | IL
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Zip | 60604-4203
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Country | US
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Telephone | 908-377-8474
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Fax |
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Provider Business Mailing Address
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Address Line | 310 S MICHIGAN AVE UNIT 1308
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City | CHICAGO
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State | IL
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Zip | 60604-4203
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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 | OWNER, SLP, AND LEARNING SPECIALIST
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Name | DR. JESSICA WACKER
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Credential | SLP.D CCC-SLP
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Telephone | 773-720-0646
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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 | 146011197
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License Number State | IL
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