Provider Demographics
NPI:1871573675
Name:MOLLOY, AAMI N (AUD)
Entity type:Individual
Prefix:
First Name:AAMI
Middle Name:N
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:AAMI
Other - Middle Name:N
Other - Last Name:OSTERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC/A
Mailing Address - Street 1:435 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5189
Mailing Address - Country:US
Mailing Address - Phone:815-399-5279
Mailing Address - Fax:
Practice Address - Street 1:435 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5189
Practice Address - Country:US
Practice Address - Phone:815-399-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147001007Medicaid
IL207034Medicare PIN
ILP47705Medicare UPIN