Individual
DR. JESSICA WACKER I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
310 S MICHIGAN AVE, 1511, CHICAGO, IL 60604-4207
(908) 377-8474
Mailing address
310 S MICHIGAN AVE UNIT 1308, CHICAGO, IL 60604-4203
(737) 200-6467
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146011197
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14043931
AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
IL
Enumeration date
01/13/2015
Last updated
11/12/2021
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