Provider Demographics
NPI:1821505744
Name:STASTNY, NINA ELIZABETH (MHS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:ELIZABETH
Last Name:STASTNY
Suffix:
Gender:F
Credentials:MHS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 HENLEY LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1955
Mailing Address - Country:US
Mailing Address - Phone:630-220-4564
Mailing Address - Fax:
Practice Address - Street 1:605 EDWARD DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-6507
Practice Address - Country:US
Practice Address - Phone:815-556-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist