Healthcare Provider Details

I. General information

NPI: 1700797172
Provider Name (Legal Business Name): STEPHANIE SUMMY M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24226 W BEACH GROVE RD
ANTIOCH IL
60002-2234
US

IV. Provider business mailing address

3005 FARMINGTON DR
LINDENHURST IL
60046-4964
US

V. Phone/Fax

Practice location:
  • Phone: 847-395-1105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.018170
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: