Provider Demographics
NPI:1043987308
Name:PASTERNOCK, ANNE MARIE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:PASTERNOCK
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 KILLDEER DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2324
Mailing Address - Country:US
Mailing Address - Phone:630-512-7316
Mailing Address - Fax:
Practice Address - Street 1:24402 W LOCKPORT ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-4206
Practice Address - Country:US
Practice Address - Phone:815-782-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist