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General NPI Number Information
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NPI Number | 1659937308
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Entity Type | Individual
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Provider Name | STEPHANIE LANDON MS
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Gender | Male
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 222 E WILLOW AVE
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City | WHEATON
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State | IL
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Zip | 60187-5426
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Country | US
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Telephone | 630-319-3841
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 SILVERSTONE DR
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City | CARPENTERSVILLE
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State | IL
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Zip | 60110-1197
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Country | US
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Telephone | 847-338-9600
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180.012191
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License Number State | IL
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