Provider Demographics
NPI:1598314072
Name:STADTHERR, SHAWNA GRACE
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:GRACE
Last Name:STADTHERR
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 1:2925 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4063
Mailing Address - Country:US
Mailing Address - Phone:630-338-2263
Mailing Address - Fax:
Practice Address - Street 1:2925 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4063
Practice Address - Country:US
Practice Address - Phone:630-338-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2170004142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant