Provider Demographics
NPI:1346808912
Name:SUNVOLD, MARY SAVANNAH (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SAVANNAH
Last Name:SUNVOLD
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3657 N JANSSEN AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3707
Mailing Address - Country:US
Mailing Address - Phone:757-803-8592
Mailing Address - Fax:
Practice Address - Street 1:320 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2315
Practice Address - Country:US
Practice Address - Phone:708-524-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242.005252OtherIDFPR