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General NPI Number Information
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NPI Number | 1487911970
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Entity Type | Organization
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Legal Business Name | HOOLSEMA THERAPY, INC
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 6612 MAJESTIC WAY
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City | CARPENTERSVILLE
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State | IL
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Zip | 60110
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Country | US
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Telephone | 847-702-7195
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Fax | 847-836-1068
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Provider Business Mailing Address
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Address Line | 6612 MAJESTIC WAY
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City | CARPENTERSVILLE
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State | IL
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Zip | 60110
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Country | US
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Telephone | 847-702-7195
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Fax | 847-836-1068
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVANNE M HOOLSEMA
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Credential | PHD, CCC-SLP
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Telephone | 847-702-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 146003795
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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