Provider Demographics
NPI:1407240302
Name:MULLEN-KROLL, ANNA K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:MULLEN-KROLL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3199 N 400 ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:IL
Mailing Address - Zip Code:62080-2413
Mailing Address - Country:US
Mailing Address - Phone:814-218-5902
Mailing Address - Fax:
Practice Address - Street 1:3199 N 400 ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:IL
Practice Address - Zip Code:62080-2413
Practice Address - Country:US
Practice Address - Phone:814-218-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146015125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist