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General NPI Number Information
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NPI Number | 1851459630
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Entity Type | Individual
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Provider Name | JONATHAN LOVE CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 17070 S PARK AVE OLIVIA'S PLACE
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3389
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Country | US
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Telephone | 708-825-1116
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Fax | 708-825-1268
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Provider Business Mailing Address
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Address Line | 6941 S CRANDON AVE
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City | CHICAGO
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State | IL
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Zip | 60649-1715
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Country | US
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Telephone | 312-933-0127
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Fax | 708-825-1268
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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 | 146.008354
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License Number State | IL
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