Provider Demographics
NPI:1770150591
Name:STRAIN, MOLLIE
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:STRAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6653 N PRICE LN
Mailing Address - Street 2:
Mailing Address - City:BONNIE
Mailing Address - State:IL
Mailing Address - Zip Code:62816-3236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6653 N PRICE LN
Practice Address - Street 2:
Practice Address - City:BONNIE
Practice Address - State:IL
Practice Address - Zip Code:62816-3236
Practice Address - Country:US
Practice Address - Phone:618-231-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146016623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist