Healthcare Provider Details

I. General information

NPI: 1427966894
Provider Name (Legal Business Name): STEPHANIE OCAMPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 S AUSTIN BLVD
CICERO IL
60804-3139
US

IV. Provider business mailing address

3647 SCOVILLE AVE
BERWYN IL
60402-3881
US

V. Phone/Fax

Practice location:
  • Phone: 708-652-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.018842
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: