1881814978 NPI number — MRS. MARY AMELIA DUMLAO MA LCPC

Table of content: MRS. MARY AMELIA DUMLAO MA LCPC (NPI 1881814978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881814978 NPI number — MRS. MARY AMELIA DUMLAO MA LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMLAO
Provider First Name:
MARY
Provider Middle Name:
AMELIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881814978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8280 KEARNEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-427-0995
Provider Business Mailing Address Fax Number:
630-427-0997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 CHESTNUT
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
HINSDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-850-9650
Provider Business Practice Location Address Fax Number:
630-850-9607
Provider Enumeration Date:
04/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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