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General NPI Number Information
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NPI Number | 1881025385
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Entity Type | Individual
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Provider Name | JACQUELINE AREVALO-AGNE SLP
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Gender | Female
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 6313 S OAK PARK AVE #3
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City | CHICAGO
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State | IL
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Zip | 60638-4001
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Country | US
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Telephone | 773-543-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 6313 S OAK PARK AVE #3
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City | CHICAGO
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State | IL
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Zip | 60638-4001
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Country | US
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Telephone | 773-543-5410
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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 | 242002565
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License Number State | IL
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