Provider Demographics
NPI:1700293818
Name:STUEPFERT, KATHERINE MARIE (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:STUEPFERT
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2202 GRAVENHURST DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-4159
Mailing Address - Country:US
Mailing Address - Phone:309-310-6336
Mailing Address - Fax:
Practice Address - Street 1:19 LATEER DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3925
Practice Address - Country:US
Practice Address - Phone:309-310-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist