Provider Demographics
NPI:1760900609
Name:EPPLIN, ALI RENEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALI
Middle Name:RENEE
Last Name:EPPLIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:ALI
Other - Middle Name:RENEE
Other - Last Name:HOLFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:8714 EASTGATE ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-3909
Mailing Address - Country:US
Mailing Address - Phone:618-318-1430
Mailing Address - Fax:
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TAMAROA
Practice Address - State:IL
Practice Address - Zip Code:62888-4312
Practice Address - Country:US
Practice Address - Phone:618-496-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist