Provider Demographics
NPI:1992831333
Name:VIOLANTE, MARY OLIVIA GABRIELLE (MA CCC SLP)
Entity Type:Individual
Prefix:MISS
First Name:MARY OLIVIA
Middle Name:GABRIELLE
Last Name:VIOLANTE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1103 W BARRY AVE
Mailing Address - Street 2:3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4375
Mailing Address - Country:US
Mailing Address - Phone:630-743-1701
Mailing Address - Fax:
Practice Address - Street 1:1103 W BARRY AVE
Practice Address - Street 2:3W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4375
Practice Address - Country:US
Practice Address - Phone:630-743-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
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