Provider Demographics
NPI:1831545540
Name:BANKS, STEFANIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:STEFANIE
Other - Middle Name:LYNN
Other - Last Name:SHIPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:107 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62285-1617
Mailing Address - Country:US
Mailing Address - Phone:618-235-4600
Mailing Address - Fax:
Practice Address - Street 1:107 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SMITHTON
Practice Address - State:IL
Practice Address - Zip Code:62285-1617
Practice Address - Country:US
Practice Address - Phone:618-235-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist