Healthcare Provider Details

I. General information

NPI: 1700438538
Provider Name (Legal Business Name): STEPHANIE KUIPERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EASTGATE DR
WASHINGTON IL
61571-9236
US

IV. Provider business mailing address

2856 193RD PL
LANSING IL
60438-3734
US

V. Phone/Fax

Practice location:
  • Phone: 309-423-3111
  • Fax:
Mailing address:
  • Phone: 708-928-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: