Provider Demographics
NPI:1851459630
Name:LOVE, JONATHAN (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:LOVE
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 S CRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1715
Mailing Address - Country:US
Mailing Address - Phone:312-933-0127
Mailing Address - Fax:708-825-1268
Practice Address - Street 1:17070 S PARK AVE
Practice Address - Street 2:OLIVIA'S PLACE
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3389
Practice Address - Country:US
Practice Address - Phone:708-825-1116
Practice Address - Fax:708-825-1268
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist