Provider Demographics
NPI:1083891402
Name:STEPHENSON, CHRISTINE KELLY
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:KELLY
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:KELLY
Other - Last Name:WHELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10171 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-2345
Mailing Address - Country:US
Mailing Address - Phone:847-669-6648
Mailing Address - Fax:
Practice Address - Street 1:10171 BENNINGTON DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-2345
Practice Address - Country:US
Practice Address - Phone:847-669-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist