Provider Demographics
NPI:1780700732
Name:O'MALLEY, JULIE K (SLP-AL)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:K
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:SLP-AL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18823 GREENBAY AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3428
Mailing Address - Country:US
Mailing Address - Phone:708-212-5740
Mailing Address - Fax:
Practice Address - Street 1:22108 PRINCETON CIR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-8503
Practice Address - Country:US
Practice Address - Phone:708-717-4924
Practice Address - Fax:815-464-8431
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.0000752355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant