Jennifer M Mauck Dba Bloom Into Speech

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146006465 Issued in IL

Legal business name

JENNIFER M MAUCK DBA BLOOM INTO SPEECH

Practice address

164 N Myrtle Ave
Elmhurst, IL 60126-2625

Phone

(773) 771-2386

Fax

(630) 279-0357

NPI assigned

Jul 13, 2009

Organization subpart

No

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

Authorized official

Name

Karin Richter

Title

Billing Service

Phone

(847) 769-5316

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1730318668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 N MYRTLE AVE",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262625",
            "telephone_number": "773-771-2386",
            "fax_number": "630-279-0357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 N MYRTLE AVE",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262625",
            "telephone_number": "773-771-2386",
            "fax_number": "630-279-0357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER M MAUCK DBA BLOOM INTO SPEECH",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "RICHTER",
        "authorized_official_first_name": "KARIN",
        "authorized_official_title_or_position": "BILLING SERVICE",
        "authorized_official_telephone_number": "847-769-5316"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146006465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351701468",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Elmhurst, IL
• Providers in Elmhurst, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; 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.