Provider Demographics
NPI:1053926592
Name:DURNIL, JACKLYN LOUISE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JACKLYN
Middle Name:LOUISE
Last Name:DURNIL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 TALBOT LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1136
Mailing Address - Country:US
Mailing Address - Phone:847-505-6443
Mailing Address - Fax:
Practice Address - Street 1:818 E GRASS LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-7470
Practice Address - Country:US
Practice Address - Phone:847-838-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist