Provider Demographics
NPI:1992387989
Name:COSENTINO, STACEY KLOUDA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:KLOUDA
Last Name:COSENTINO
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5264
Mailing Address - Country:US
Mailing Address - Phone:630-824-7311
Mailing Address - Fax:
Practice Address - Street 1:1357 VIKING DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3909
Practice Address - Country:US
Practice Address - Phone:630-463-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242005854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist