Provider Demographics
NPI:1992434963
Name:HAVLIC, MOLLY GRACE (MS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:GRACE
Last Name:HAVLIC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ALPINE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2305
Mailing Address - Country:US
Mailing Address - Phone:847-361-5051
Mailing Address - Fax:
Practice Address - Street 1:1905 ARGONNE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-2500
Practice Address - Country:US
Practice Address - Phone:847-689-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14380847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist