Provider Demographics
NPI:1730693367
Name:MULCHRONE, SHELLEY (MRS)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:MULCHRONE
Suffix:
Gender:F
Credentials:MRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 S CHOCTAW RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2007
Mailing Address - Country:US
Mailing Address - Phone:708-254-9663
Mailing Address - Fax:
Practice Address - Street 1:7700 W 127TH ST
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1257
Practice Address - Country:US
Practice Address - Phone:708-448-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.001697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist