Healthcare Provider Details

I. General information

NPI: 1891400941
Provider Name (Legal Business Name): ASPIRE SPEECH, LANGUAGE AND LISTENING THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E LINCOLN ST STE 209
NORMAL IL
61761-6406
US

IV. Provider business mailing address

24 LATEER DR
NORMAL IL
61761-3926
US

V. Phone/Fax

Practice location:
  • Phone: 309-310-6336
  • Fax: 888-972-5334
Mailing address:
  • Phone: 309-310-6336
  • Fax: 888-972-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE MARIE STUEPFERT
Title or Position: OWNER / CLINICAL DIRECTOR
Credential: MS, CCC-SLP/L
Phone: 309-310-6336