Jeanette Dorit Pacanowski, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242004088 Issued in IL

Practice address

525 Tyler Rd Ste Q1
St Charles, IL 60174-3360

Phone

(630) 444-0077

Fax

(630) 444-0078

NPI assigned

Aug 11, 2016

Last updated

Jan 7, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1558815282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 TYLER RD STE Q1",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601743360",
            "telephone_number": "630-444-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 TYLER RD STE Q1",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601743360",
            "telephone_number": "630-444-0077",
            "fax_number": "630-444-0078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40W310 Lafox Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Charles",
            "state": "IL",
            "postal_code": "601756588",
            "country_code": "US",
            "telephone_number": "630-893-7995",
            "fax_number": "630-893-2517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACANOWSKI",
        "first_name": "JEANETTE",
        "middle_name": "DORIT",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-11",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242004088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in St Charles, IL
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• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.