Provider Demographics
NPI:1245738491
Name:STAKE, MAGGIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:STAKE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 E WING ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6569
Mailing Address - Country:US
Mailing Address - Phone:847-226-1749
Mailing Address - Fax:
Practice Address - Street 1:2060 OTAY LAKES RD UNIT 270
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1364
Practice Address - Country:US
Practice Address - Phone:619-546-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist