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General NPI Number Information
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NPI Number | 1619480886
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Entity Type | Individual
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Provider Name | STACEY ERICKSON-ZALE
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Gender | Female
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 780 SHORELINE DR
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City | AURORA
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State | IL
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Zip | 60504-6192
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Country | US
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Telephone | 630-375-3640
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Fax |
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Provider Business Mailing Address
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Address Line | 1N179 PAPWORTH ST
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City | CAROL STREAM
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State | IL
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Zip | 60188-2318
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Country | US
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Telephone | 815-861-3175
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Fax |
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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 | 146.006373
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License Number State | IL
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