MEDICARE: MARY STEFELY M.A., 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	146001426	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001606362	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1518096049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY STEFELY M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	908 GREENFIELD CT
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1365
Country	:	US
Telephone Number	:	847-997-8724
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 GREENFIELD CT
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1365
Country	:	US
Telephone Number	:	847-997-8724
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	01/14/2021

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