Individual
JESSICA DIETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1422 W WILLOW ST, CHICAGO, IL 60642-8978
(312) 399-0370
Mailing address
1422 W WILLOW ST, CHICAGO, IL 60642-8978
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14194079
IL
Other
Enumeration date
06/06/2019
Last updated
06/06/2019
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