Provider Demographics
NPI:1609121946
Name:BECERRIL, STEFANIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:BECERRIL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:LEAFBLAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 CHATEAU PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4723
Mailing Address - Country:US
Mailing Address - Phone:847-445-9511
Mailing Address - Fax:
Practice Address - Street 1:405 CHATEAU PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4723
Practice Address - Country:US
Practice Address - Phone:847-445-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107673235Z00000X
LA6769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist