Healthcare Provider Details

I. General information

NPI: 1316853591
Provider Name (Legal Business Name): EMMA ROSE MUELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SAINT JOSEPH DR
BLOOMINGTON IL
61701-3638
US

IV. Provider business mailing address

2804 RAINBOW AVE APT 6
BLOOMINGTON IL
61704-8562
US

V. Phone/Fax

Practice location:
  • Phone: 309-683-8275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242018804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: