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General NPI Number Information
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NPI Number | 1841354453
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Entity Type | Individual
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Provider Name | STACIE L NORRMAN MA CCC SLP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 673 MAPLE TRL
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5407
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Country | US
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Telephone | 630-378-0373
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Fax | 815-254-4315
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Provider Business Mailing Address
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Address Line | 673 MAPLE TRL
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5407
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Country | US
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Telephone | 630-378-0373
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Fax | 815-254-4315
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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 | 146004377
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License Number State | IL
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