Healthcare Provider Details

I. General information

NPI: 1285031005
Provider Name (Legal Business Name): STEPHANIE SCHMUCKER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE PAULIKS ATC

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 BRIARCLIFFE BLVD
WHEATON IL
60189-8504
US

IV. Provider business mailing address

5941 N NEWBURG AVE
CHICAGO IL
60631-2636
US

V. Phone/Fax

Practice location:
  • Phone: 630-234-8393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.003354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: