Individual
MRS. GWEN DIANE STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SPEECH PATHOLOGIST
Contact information
Practice address
526 GOODSILL DR, EAST GALESBURG, IL 61430-9731
(309) 341-1650
Mailing address
526 GOODSILL DR, EAST GALESBURG, IL 61430-9731
(309) 341-1650
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146-002978
IL
Other
Enumeration date
01/21/2010
Last updated
01/21/2010
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