Healthcare Provider Details

I. General information

NPI: 1306358841
Provider Name (Legal Business Name): AMBER MUELLER MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRANKS RD
MARENGO IL
60152-3425
US

IV. Provider business mailing address

10636 ORTH RD
GARDEN PRAIRIE IL
61038-9735
US

V. Phone/Fax

Practice location:
  • Phone: 815-568-6511
  • Fax:
Mailing address:
  • Phone: 815-751-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1460008313
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: