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General NPI Number Information
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NPI Number | 1457472987
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Entity Type | Individual
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Provider Name | LINDA ANN STANISH
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 210 CIRCLE AVE
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1743
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Country | US
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Telephone | 630-310-9148
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Fax | 630-529-1386
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Provider Business Mailing Address
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Address Line | 210 CIRCLE AVE
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1743
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Country | US
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Telephone | 630-310-9148
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Fax | 630-529-1386
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | LS49550299P
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License Number State | IL
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