Richardson, Stacey

Richardson, Stacey is an individual health care provider with primary practice located at 17736 Sycamore Ave , Country Club Hills IL 60478-4870. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist, which is considered as her primary health care specialty. Richardson, Stacey can be contacted via phone (708) 408-1320.

Contact Information

Primary practice address
17736 Sycamore Ave Country Club Hills IL 60478-4870
Phone: (708) 408-1320
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist 222Q00000X SR39520701A Illinois

Profile Details

NPI number 1740498930
LBN Legal business name Richardson, Stacey
Credentials DTA
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740498930 NPPES
Illinois Other SR39520701A DTA CREDENTIAL

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