Healthcare Provider Details

I. General information

NPI: 1831766518
Provider Name (Legal Business Name): STEPHANIE LYNN ZILCH RRT-NPS, ACCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 S MESA DR
PEORIA IL
61607-1157
US

IV. Provider business mailing address

12225 GREENVILLE AVE # 600
DALLAS TX
75243-9362
US

V. Phone/Fax

Practice location:
  • Phone: 309-645-0229
  • Fax:
Mailing address:
  • Phone: 469-249-1887
  • Fax: 877-788-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number194006178
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: