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General NPI Number Information
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NPI Number | 1730394073
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Entity Type | Individual
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Provider Name | STEPHEN G. VINCENT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 450 S DURKIN DR STE. C
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7212
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Country | US
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Telephone | 217-793-1567
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Fax | 217-793-1930
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Provider Business Mailing Address
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Address Line | 450 S DURKIN DR STE. C
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7212
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Country | US
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Telephone | 217-793-1567
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Fax | 217-793-1930
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 71-3280
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 71-3280
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 71-3280
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1999140679
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License Number State | MO
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