Provider Demographics
NPI:1952002446
Name:OBENHAUS, STEFANIE MARIE
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MARIE
Last Name:OBENHAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1127
Mailing Address - Country:US
Mailing Address - Phone:563-526-3791
Mailing Address - Fax:
Practice Address - Street 1:502 N STATE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN GROVE
Practice Address - State:IL
Practice Address - Zip Code:61031-9773
Practice Address - Country:US
Practice Address - Phone:815-456-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146015997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist