Active NPI
Treacie Gill Jelks
- Speech-Language Assistant
- Matteson, IL
National Provider Identifier
1508163163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 29001424A
- Practice address
- 4710 Lincoln Hwy
Matteson, IL 60443-2316 - Phone
- (708) 570-1665
- NPI assigned
- Feb 17, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | 29001424A | IN | Primary |
Addresses
Primary practice location
4710 Lincoln Hwy
Matteson, IL 60443-2316
Mailing address
2521 West 21 Avenue
Gary, IN 46404-2904
Phone (219) 949-6501
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29001424A | IN | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297900800000",
"number": "1508163163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2521 WEST 21 AVENUE",
"city": "GARY",
"state": "IN",
"postal_code": "464042904",
"telephone_number": "219-949-6501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4710 LINCOLN HWY",
"city": "MATTESON",
"state": "IL",
"postal_code": "604432316",
"telephone_number": "708-570-1665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JELKS",
"first_name": "TREACIE",
"middle_name": "GILL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-17",
"last_updated": "2011-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "IN",
"license": "29001424A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Matteson, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.