Provider Demographics
NPI:1093087843
Name:HULLIUNG, JENNY L (SLP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:HULLIUNG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W HARNETT ST
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-1362
Mailing Address - Country:US
Mailing Address - Phone:618-566-7414
Mailing Address - Fax:618-448-0507
Practice Address - Street 1:846 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-1153
Practice Address - Country:US
Practice Address - Phone:618-234-9705
Practice Address - Fax:618-257-0665
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010586235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist