Provider Demographics
NPI:1992238588
Name:ROCCO, MARY JANE (MS - SLP)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:ROCCO
Suffix:
Gender:F
Credentials:MS - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4484
Mailing Address - Country:US
Mailing Address - Phone:312-371-1141
Mailing Address - Fax:
Practice Address - Street 1:252 CLAREMONT DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4484
Practice Address - Country:US
Practice Address - Phone:312-371-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist