Basic Information
| Provider Information | |||||||||
| NPI: | 1417153842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULLIHAN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 S SPRING AVE | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605252752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084820445 | ||||||||
| FaxNumber: | 7084820665 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 HIGH GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605277585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309202900 | ||||||||
| FaxNumber: | 6309202453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.