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General NPI Number Information
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NPI Number | 1558415034
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Entity Type | Individual
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Provider Name | DIANE STEPHENSON PH D
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 1101 LAKE ST STE 405H
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City | OAK PARK
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State | IL
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Zip | 60301-1071
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Country | US
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Telephone | 708-524-9513
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Fax | 630-604-1115
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Provider Business Mailing Address
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Address Line | 930 ONTARIO ST APT 3C
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City | OAK PARK
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State | IL
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Zip | 60302-1938
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Country | US
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Telephone | 708-302-5716
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004319
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License Number State | IL
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