Healthcare Provider Details

I. General information

NPI: 1184298382
Provider Name (Legal Business Name): JULIA CALLAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COMMONS DR STE 102
AURORA IL
60504-4155
US

IV. Provider business mailing address

626 ANDERSON BLVD
GENEVA IL
60134-1245
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-1820
  • Fax:
Mailing address:
  • Phone: 630-347-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14302804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: