Provider Demographics
NPI:1801198254
Name:MULROONEY, ANNA LEWIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEWIS
Last Name:MULROONEY
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 1:1412 JONESTER CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2870
Mailing Address - Country:US
Mailing Address - Phone:828-333-8385
Mailing Address - Fax:
Practice Address - Street 1:1412 JONESTER CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2870
Practice Address - Country:US
Practice Address - Phone:828-333-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12097146OtherASHA NUMBER
NC8744OtherNC SLP LICENSE
ILAL99760412POtherIL EI CREDENTIAL NUMBER
IL146010550OtherSLP IL LICENSE