Provider Demographics
NPI:1922258557
Name:MULVENNA, HOLLY B (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:B
Last Name:MULVENNA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 W ROSCOE ST
Mailing Address - Street 2:UNIT 1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6245
Mailing Address - Country:US
Mailing Address - Phone:773-972-0864
Mailing Address - Fax:
Practice Address - Street 1:2307 W ROSCOE ST
Practice Address - Street 2:UNIT 1W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6245
Practice Address - Country:US
Practice Address - Phone:773-972-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist