Provider Demographics
NPI:1861920365
Name:GEVELINGER, JULIA R (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:GEVELINGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:R
Other - Last Name:KENNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:13400 S ROUTE 59 STE 116-326
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5696
Mailing Address - Country:US
Mailing Address - Phone:815-267-7334
Mailing Address - Fax:
Practice Address - Street 1:13400 S ROUTE 59 STE 116-326
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5696
Practice Address - Country:US
Practice Address - Phone:815-267-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-28
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL146.015249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program