Active NPI
Jeannine Stupka, M.A. CCC-SLP
- Speech-Language Pathologist
- Downers Grove, IL
National Provider Identifier
1700279569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.012547
- Practice address
- 5002 Main St
Suite 4
Downers Grove, IL 60515-3659 - Phone
- (630) 929-0122
- NPI assigned
- Mar 17, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.012547 | IL | Primary |
| Speech-Language Pathologist | 235Z00000X | SP 19031 | CA |
Addresses
Primary practice location
5002 Main St
Suite 4
Downers Grove, IL 60515-3659
Mailing address
5002 Main St
Suite 4
Downers Grove, IL 60515-3659
Phone (630) 929-0122
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
| License | State | Type | Specialty |
|---|---|---|---|
| SP 19031 | CA | MD | Speech-Language Pathologist |
| 146.012547 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426550400000",
"number": "1700279569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5002 MAIN ST",
"address_2": "SUITE 4",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "605153659",
"telephone_number": "630-929-0122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5002 MAIN ST",
"address_2": "SUITE 4",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "605153659",
"telephone_number": "630-929-0122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUPKA",
"first_name": "JEANNINE",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-17",
"last_updated": "2015-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.012547",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP 19031",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Downers Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.