Provider Demographics
NPI:1316197916
Name:GOLEY, ALISON
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:GOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9438 W LAKE CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IL
Mailing Address - Zip Code:61547-9328
Mailing Address - Country:US
Mailing Address - Phone:630-740-1182
Mailing Address - Fax:309-697-5574
Practice Address - Street 1:9438 W LAKE CAMELOT DR
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:IL
Practice Address - Zip Code:61547
Practice Address - Country:US
Practice Address - Phone:630-740-1182
Practice Address - Fax:309-697-5574
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist