Provider Demographics
NPI:1063035376
Name:REHANI, STEPHANIE NATALIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NATALIE
Last Name:REHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PLEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7412
Mailing Address - Country:US
Mailing Address - Phone:847-732-1441
Mailing Address - Fax:
Practice Address - Street 1:2413 SEMINOLE CT
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3853
Practice Address - Country:US
Practice Address - Phone:224-778-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist