Provider Demographics
NPI:1972050631
Name:LANNON, STACIE (AUD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:LANNON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:E
Other - Last Name:BEEGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1160 PARK AVE W
Mailing Address - Street 2:#4S
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2313
Practice Address - Country:US
Practice Address - Phone:847-381-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist