Provider Demographics
NPI:1780194894
Name:STELLHORN, NATASHA MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:STELLHORN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 SWORM LN
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4917
Mailing Address - Country:US
Mailing Address - Phone:618-698-0369
Mailing Address - Fax:
Practice Address - Street 1:800 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1648
Practice Address - Country:US
Practice Address - Phone:217-324-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist