Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 056005759 | IL |
NPI | 1548599046 |
---|---|
Provider Name | Stephanie Mccammon |
First Address | Chicago, IL 60612-7232 |
Second Address | Chicago, IL 60612-7232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2009 |
Last Update Date | 11/12/2009 |