MEDICARE: STEFANIE LYNN AHLBRAND 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	146004603	IL

General Provider Information

NPI Number	:	1770639007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE LYNN AHLBRAND M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	15009 CATLIN TILTON RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-5176
Country	:	US
Telephone Number	:	217-443-8273
Fax Number	:	217-443-0217

Provider Business Practice Location Address
First Line	:	15009 CATLIN TILTON RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-5176
Country	:	US
Telephone Number	:	217-443-8273
Fax Number	:	217-443-0217

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	11/26/2018

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