MEDICARE: JESSICA GROENENDYK CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	242003353	IL
2	174N00000X	Lactation Consultant (Non-RN)	ALPP-366744	IL

General Provider Information

NPI Number	:	1235516998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GROENENDYK CCC-SLP

Provider Business Mailing Address
First Line	:	1795 W STATE ST STE C
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4709
Country	:	US
Telephone Number	:	331-444-2744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1795 W STATE ST STE C
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4709
Country	:	US
Telephone Number	:	708-473-6120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	03/17/2026

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