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General NPI Number Information
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NPI Number | 1124274071
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Entity Type | Individual
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Provider Name | MARY LYNN CALDERONE M.A.C.C.C.A.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 360 E LOSEY ST
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City | GALESBURG
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State | IL
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Zip | 61401-2843
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Country | US
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Telephone | 309-343-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 582 N SEMINARY ST
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City | GALESBURG
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State | IL
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Zip | 61401-3739
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Country | US
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Telephone | 309-343-9393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147.000705
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License Number State | IL
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