Provider Demographics
NPI:1154550267
Name:VAYNER, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VAYNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 SKOKIE BLVD
Mailing Address - Street 2:SUITE 133
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2224
Mailing Address - Country:US
Mailing Address - Phone:847-990-0656
Mailing Address - Fax:847-787-5323
Practice Address - Street 1:8820 SKOKIE BLVD
Practice Address - Street 2:SUITE 133
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2224
Practice Address - Country:US
Practice Address - Phone:847-990-0656
Practice Address - Fax:847-787-5323
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.000224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist