Provider Demographics
NPI:1023783917
Name:TOLLAS, MAISON EMILY (MA-SLP)
Entity type:Individual
Prefix:
First Name:MAISON
Middle Name:EMILY
Last Name:TOLLAS
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28100 TORCH PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4026
Mailing Address - Country:US
Mailing Address - Phone:630-413-5800
Mailing Address - Fax:
Practice Address - Street 1:1050 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5169
Practice Address - Country:US
Practice Address - Phone:630-333-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist