Provider Demographics
NPI:1245866466
Name:GILLILAND, LYNNE MARIE (HIS)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 S ROUTE 59 STE 120
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9108
Mailing Address - Country:US
Mailing Address - Phone:630-585-5911
Mailing Address - Fax:
Practice Address - Street 1:256 S ROUTE 59 STE 120
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9108
Practice Address - Country:US
Practice Address - Phone:630-585-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3222237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist