Provider Demographics
NPI:1275014375
Name:LUNA, MARY FRANCINE I (MS CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCINE
Last Name:LUNA
Suffix:I
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:FRANCINE
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP/L
Mailing Address - Street 1:3047 N OAKLEY AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7997
Mailing Address - Country:US
Mailing Address - Phone:815-353-2503
Mailing Address - Fax:
Practice Address - Street 1:3047 N OAKLEY AVE UNIT 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7997
Practice Address - Country:US
Practice Address - Phone:815-353-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006647A235Z00000X
IL146.013680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist