Provider Demographics
NPI:1992842181
Name:STURGULEWSKI, STACEY KATHLEEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:KATHLEEN
Last Name:STURGULEWSKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 N 78TH CT
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-1018
Mailing Address - Country:US
Mailing Address - Phone:312-259-8378
Mailing Address - Fax:
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:AUDIOLOGY AND SPEECH - 126
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-5260
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001169231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147-001169OtherSTATE LICENSE