Provider Demographics
NPI:1124539887
Name:PAOLELLO, STACEY (MHS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:PAOLELLO
Suffix:
Gender:F
Credentials:MHS, CCC/SLP
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHS, CCC/SLP
Mailing Address - Street 1:24110 NORFOLK LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14731 S VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-3185
Practice Address - Country:US
Practice Address - Phone:815-267-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist