Provider Demographics
NPI:1679910079
Name:MCMEEN, MOLLIE (SLP)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:MCMEEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 W VAN WINKLE WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7483
Mailing Address - Country:US
Mailing Address - Phone:309-693-9189
Mailing Address - Fax:309-693-9946
Practice Address - Street 1:2338 W VAN WINKLE WAY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7483
Practice Address - Country:US
Practice Address - Phone:309-693-9189
Practice Address - Fax:309-693-9946
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist