Basic Information
| Provider Information | |||||||||
| NPI: | 1902293913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JELIAZKOVA | ||||||||
| FirstName: | SILVIA | ||||||||
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| Credential: | MS, CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620252404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186048542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 N 27TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622266621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182356995 | ||||||||
| FaxNumber: | 6182356995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2015 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 242.003170 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.