Provider Demographics
NPI:1023137015
Name:HAFELE, STACY ANNE (MS)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANNE
Last Name:HAFELE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 W MINERS DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9046
Mailing Address - Country:US
Mailing Address - Phone:309-219-3245
Mailing Address - Fax:309-243-9631
Practice Address - Street 1:2209 W MINERS DR
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IL
Practice Address - Zip Code:61525-9046
Practice Address - Country:US
Practice Address - Phone:309-219-3245
Practice Address - Fax:309-243-9631
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist