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NPI Code Detail

MEDICARE: MISS JUSTINE MARGARET DISTEFANO M.ED.

MEDICARE: MISS JUSTINE MARGARET DISTEFANO M.ED.
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
1235Z00000XSpeech-Language PathologistIL

General Provider Information

NPI Number : 1538536388
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JUSTINE MARGARET DISTEFANO M.ED.
Provider Business Mailing Address
First Line : 124 LAKESIDE DR
Second Line : APT #526
City : SAINT CHARLES
State : IL
Zip : 60174-7910
Country : US
Telephone Number : 716-400-8109
Fax Number :
Provider Business Practice Location Address
First Line : 124 LAKESIDE DR
Second Line : APT #526
City : SAINT CHARLES
State : IL
Zip : 60174-7910
Country : US
Telephone Number : 716-400-8109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2015
Last Update Date : 08/27/2015

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Directions to “ MISS JUSTINE MARGARET DISTEFANO M.ED.” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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