Stacy Irene Dejong, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146012745 Issued in IL

Practice address

20912 S Frankfort Square Rd
Frankfort, IL 60423-8123

Phone

(815) 469-6993

NPI assigned

Dec 5, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Stacy Irene Maag Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512432000000",
    "number": "1437664059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18110 DORCHESTER AVE",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604381511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20912 S FRANKFORT SQUARE RD",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604238123",
            "telephone_number": "815-469-6993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "STACY",
        "middle_name": "IRENE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-05",
        "last_updated": "2017-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146012745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "MAAG",
            "middle_name": "IRENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ryan Matthew Decker
• Mary Defrank, SLP
• John J. Deitche, PH.D.
• Victoria Lyn Deitche, LCSW
• Bridie Supple Deiters, PT
• Heather Dawn Dekrey, OTR/L
• Cristina Sujey Deluna Perez
• Denali Dental PLLC
• Dental Boutique
• Dental Professionals of Illinois, P.C. (Complete Dental of Frankfort)

• Speech-Language Pathologist in Frankfort, IL
• Providers in Frankfort, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.