Provider Demographics
NPI:1528121829
Name:FROGLEY, MAUREEN ELLEN (CCC-SLP-L)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ELLEN
Last Name:FROGLEY
Suffix:
Gender:F
Credentials:CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-5832
Mailing Address - Country:US
Mailing Address - Phone:217-369-5898
Mailing Address - Fax:217-344-9031
Practice Address - Street 1:1702 S VINE ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-5832
Practice Address - Country:US
Practice Address - Phone:217-344-2937
Practice Address - Fax:217-344-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01032068OtherBLUE CROSS BLUE SHIELD