Provider Demographics
NPI:1528185576
Name:O'DONAGHUE, JULIA ROLL (MS)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ROLL
Last Name:O'DONAGHUE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 W HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1805
Mailing Address - Country:US
Mailing Address - Phone:773-338-8733
Mailing Address - Fax:
Practice Address - Street 1:307 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4140
Practice Address - Country:US
Practice Address - Phone:312-238-6854
Practice Address - Fax:312-238-6851
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist