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General NPI Number Information
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NPI Number | 1053452185
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Entity Type | Individual
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Provider Name | ANNE STEFANSKI-DOUGLAS MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 1133 N DEARBORN ST #2904
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City | CHICAGO
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State | IL
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Zip | 60610-2783
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Country | US
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Telephone | 312-915-0374
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Fax | 312-915-0374
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Provider Business Mailing Address
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Address Line | 422 N. SCOVILLE AVENUE
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City | OAK PARK
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State | IL
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Zip | 60302
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Country | US
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Telephone | 708-613-5824
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Fax | 708-613-5824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146-005994
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License Number State | IL
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