Provider Demographics
NPI:1487911970
Name:HOOLSEMA THERAPY, INC
Entity type:Organization
Organization Name:HOOLSEMA THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOOLSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:847-702-7195
Mailing Address - Street 1:6612 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110
Mailing Address - Country:US
Mailing Address - Phone:847-702-7195
Mailing Address - Fax:847-836-1068
Practice Address - Street 1:6612 MAJESTIC WAY
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110
Practice Address - Country:US
Practice Address - Phone:847-702-7195
Practice Address - Fax:847-836-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003795252Y00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty