Provider Demographics
NPI:1487112579
Name:LIBERTI, JENNIFER (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LIBERTI
Suffix:
Gender:F
Credentials:MS, 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 1:3N650 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1912
Mailing Address - Country:US
Mailing Address - Phone:630-254-0519
Mailing Address - Fax:
Practice Address - Street 1:1201 W NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3667
Practice Address - Country:US
Practice Address - Phone:630-301-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist