MEDICARE: MRS. ANNE STEFANSKI-DOUGLAS MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146-005994	IL

General Provider Information

NPI Number	:	1053452185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE STEFANSKI-DOUGLAS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	422 N. SCOVILLE AVENUE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302
Country	:	US
Telephone Number	:	708-613-5824
Fax Number	:	708-613-5824

Provider Business Practice Location Address
First Line	:	1133 N DEARBORN ST
Second Line	:	#2904
City	:	CHICAGO
State	:	IL
Zip	:	60610-2783
Country	:	US
Telephone Number	:	312-915-0374
Fax Number	:	312-915-0374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	07/15/2015

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