Individual provider Active NPI

Jihyun Jung, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Villa Park, IL
National Provider Identifier
1114533080
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146.016204 Issued in IL
Practice address
830 S Addison Ave
Villa Park, IL 60181-2877
Phone
(630) 620-4433
NPI assigned
Sep 16, 2020
Last updated
Sep 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 146.016204 IL Primary
Speech-Language Pathologist 235Z00000X 242.006048 IL

Addresses

Primary practice location

830 S Addison Ave
Villa Park, IL 60181-2877

Mailing address

830 S Addison Ave
Villa Park, IL 60181-2877
Phone (413) 992-7149

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
146.016204ILMDSpeech-Language Pathologist
242.006048ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Easter Seals Dupage and the Fox Valley Region Speech-Language Pathologist Past Accepting new patients
Easter Seals Dupage and the Fox Valley Region Speech-Language Pathologist PastSince Mar 14, 2017 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1114533080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 S ADDISON AVE",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601812877",
            "telephone_number": "413-992-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S ADDISON AVE",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601812877",
            "telephone_number": "630-620-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNG",
        "first_name": "JIHYUN",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-16",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.016204",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.006048",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.