Healthcare Provider Details

I. General information

NPI: 1003772385
Provider Name (Legal Business Name): STEPHANIE PADILLA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BOULDER HILL PASS
MONTGOMERY IL
60538
US

IV. Provider business mailing address

21 BOULDER HILL PASS
MONTGOMERY IL
60538
US

V. Phone/Fax

Practice location:
  • Phone: 630-331-3667
  • Fax: 630-338-0048
Mailing address:
  • Phone: 630-331-3667
  • Fax: 630-338-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-450058
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: