Provider Demographics
NPI:1427261221
Name:HALLENBECK, STEPHEN ANTHONY (AUD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:HALLENBECK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MOHAWK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ILLINOIS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1128
Mailing Address - Country:US
Mailing Address - Phone:630-908-7155
Mailing Address - Fax:
Practice Address - Street 1:112 MOHAWK DRIVE
Practice Address - Street 2:
Practice Address - City:ILLINOIS
Practice Address - State:IL
Practice Address - Zip Code:60514-1128
Practice Address - Country:US
Practice Address - Phone:630-908-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist