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General NPI Number Information
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NPI Number | 1518948694
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Entity Type | Organization
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Legal Business Name | STEVENS SPEECH LANGUAGE PATHOLOGY SERVICES
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5681 NEBESHONE LN
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City | ROCKFORD
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State | IL
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Zip | 61103-8917
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Country | US
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Telephone | 815-877-2615
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Fax |
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Provider Business Mailing Address
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Address Line | 5681 NEBESHONE LN
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City | ROCKFORD
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State | IL
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Zip | 61103-8917
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Country | US
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Telephone | 815-877-2615
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PATRICIA ANNE STEVENS
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Credential |
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Telephone | 815-877-2615
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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 |
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License Number State |
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