Jessica Wacker I, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146011197 Issued in IL

Practice address

310 S Michigan Ave
1511
Chicago, IL 60604-4207

Phone

(908) 377-8474

NPI assigned

Jan 13, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Loop Speech, Language, and Learning

  • Speech-Language Pathologist
  • Chicago, IL
  • NPI 1336626316
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1073902144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S MICHIGAN AVE UNIT 1308",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606044203",
            "telephone_number": "737-200-6467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S MICHIGAN AVE",
            "address_2": "1511",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606044207",
            "telephone_number": "908-377-8474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACKER",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-13",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146011197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION",
            "identifier": "14043931",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Camille Wachholz
• Laura Wachs, OTR/L
• Kelley Nash Wachsberg
• Carrie C Wachter, LPC
• Jill Wachter
• Brittany Waclaw, PA-C
• Wadah Atassi MD SC
• Alexis Ann Waddell, MAOL
• Donald Waddell, PHARMD
• Kimberly Waddell, OTR/L

• Speech-Language Pathologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.