Healthcare Provider Details

I. General information

NPI: 1831206796
Provider Name (Legal Business Name): MARGUERITE MARY STIEFBOLD ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 COURTNEY CIR
SUGAR GROVE IL
60554-9261
US

IV. Provider business mailing address

441 COURTNEY CIR
SUGAR GROVE IL
60554-9261
US

V. Phone/Fax

Practice location:
  • Phone: 630-466-0862
  • Fax: 630-466-0862
Mailing address:
  • Phone: 630-466-0573
  • Fax: 630-466-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: