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General NPI Number Information
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NPI Number | 1538282694
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Entity Type | Individual
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Provider Name | STACY PFLUECKE M.ED., DT
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1640 W ROOSEVELT RD COLLEGE OF EDUCATION, ROOM 336, MC 628
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City | CHICAGO
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State | IL
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Zip | 60608-1316
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Country | US
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Telephone | 312-413-9338
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Fax | 312-419-1993
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Provider Business Mailing Address
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Address Line | 2730 N HARDING AVE
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City | CHICAGO
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State | IL
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Zip | 60647-1026
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Country | US
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Telephone | 773-895-4495
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Fax |
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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 |
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License Number State |
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