Individual provider Active NPI

Jean A Kienzle, SLP

  • Speech-Language Pathologist
  • Tinley Park, IL
National Provider Identifier
1578684130
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
6775 Prosperi Dr
Tinley Park, IL 60477-4789
Phone
(708) 429-1260
Fax
(708) 429-6622
NPI assigned
Apr 2, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

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

Addresses

Primary practice location

6775 Prosperi Dr
Tinley Park, IL 60477-4789

Mailing address

13037 Rhode St
Cedar Lake, IN 46303-9745
Phone (219) 374-5051

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

LicenseStateTypeSpecialty
146002019ILMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578684130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13037 RHODE ST",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463039745",
            "telephone_number": "219-374-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6775 PROSPERI DR",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604774789",
            "telephone_number": "708-429-1260",
            "fax_number": "708-429-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIENZLE",
        "first_name": "JEAN",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.