Healthcare Provider Details

I. General information

NPI: 1750446720
Provider Name (Legal Business Name): M STAGNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E SCHAUMBURG RD
SCHAUMBURG IL
60194-5166
US

IV. Provider business mailing address

1375 E SCHAUMBURG RD
SCHAUMBURG IL
60194-5166
US

V. Phone/Fax

Practice location:
  • Phone: 847-895-4540
  • Fax:
Mailing address:
  • Phone: 847-895-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number071-005066
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number071-005066
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071005066
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-005066
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: