Provider Demographics
NPI:1104337757
Name:BELITZ, JENNIFER LEIGH (MA, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:BELITZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22265 S 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9786
Mailing Address - Country:US
Mailing Address - Phone:815-469-2309
Mailing Address - Fax:
Practice Address - Street 1:22265 S 80TH AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9786
Practice Address - Country:US
Practice Address - Phone:815-469-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist