Healthcare Provider Details

I. General information

NPI: 1134542772
Provider Name (Legal Business Name): EMILY MOULIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S ARDMORE AVE
VILLA PARK IL
60181-2928
US

IV. Provider business mailing address

514 S ARDMORE AVE
VILLA PARK IL
60181-2928
US

V. Phone/Fax

Practice location:
  • Phone: 414-331-3352
  • Fax:
Mailing address:
  • Phone: 414-331-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024329
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: