Basic Information
| Provider Information | |||||||||
| NPI: | 1013414226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODSON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 N LOOMIS ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606071147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122438487 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1902 BURLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | LISLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605321721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309151051 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146013760 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7094782 | 01 | IL | EI BILLING PROVIDER | OTHER | 3000005 | 01 | IL | EI MCO | OTHER |