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General NPI Number Information
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NPI Number | 1891771648
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Entity Type | Individual
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Provider Name | THERESA JABALEY M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 111 N WABASH AVE #1618
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City | CHICAGO
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State | IL
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Zip | 60602-1903
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Country | US
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Telephone | 312-251-0100
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Fax | 312-251-0123
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Provider Business Mailing Address
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Address Line | 6 VICTORY DRIVE
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City | LIBERTY
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State | MO
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Zip | 64068
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Country | US
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Telephone | 816-883-2660
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Fax | 816-792-9819
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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 | 147000345
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License Number State | IL
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