Provider Demographics
NPI:1053452185
Name:STEFANSKI-DOUGLAS, ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:STEFANSKI-DOUGLAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:STEFANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:422 N. SCOVILLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-613-5824
Mailing Address - Fax:708-613-5824
Practice Address - Street 1:1133 N DEARBORN ST
Practice Address - Street 2:#2904
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2783
Practice Address - Country:US
Practice Address - Phone:312-915-0374
Practice Address - Fax:312-915-0374
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-005994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist