MEDICARE: JACLYN AMOS M.S., CCC-SLP/L

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	146008593	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	235Z00000X	OTHER	IL	SPEECH PATHOLOGIST

General Provider Information

NPI Number	:	1972628790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN AMOS M.S., CCC-SLP/L

Provider Business Mailing Address
First Line	:	1258 DUNAMON DR
Second Line	:
City	:	BARTLETT
State	:	IL
Zip	:	60103-1949
Country	:	US
Telephone Number	:	847-533-4723
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 E CHICAGO ST
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-6822
Country	:	US
Telephone Number	:	847-429-6131
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/15/2009

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Directions to “ JACLYN AMOS M.S., CCC-SLP/L” Practice Location

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