Healthcare Provider Details

I. General information

NPI: 1023955606
Provider Name (Legal Business Name): STACY DONNEWALD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 WINDING RIVER DR
NAPERVILLE IL
60564-8554
US

IV. Provider business mailing address

1627 CECILY DR
JOLIET IL
60435-8588
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-2846
  • Fax:
Mailing address:
  • Phone: 815-483-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-504149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: