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General NPI Number Information
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NPI Number | 1760926471
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE CHAMBERS-BALTZ PHD, LP
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Gender | Female
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1705 W FREEMAN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-2103
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Country | US
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Telephone | 507-421-2750
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 W FREEMAN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-2103
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Country | US
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Telephone | 507-421-2750
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 071011145
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License Number State | IL
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