Provider Demographics
NPI:1255987749
Name:HULBERT, MOLLY (MS SLP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HULBERT
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 N MARSHFIELD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6959
Mailing Address - Country:US
Mailing Address - Phone:980-395-0867
Mailing Address - Fax:
Practice Address - Street 1:3654 N LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3725
Practice Address - Country:US
Practice Address - Phone:980-395-0867
Practice Address - Fax:773-755-8126
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist