Provider Demographics
NPI:1225006356
Name:STEPANICH, JAMES V (ATC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:STEPANICH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15W706 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5140
Mailing Address - Country:US
Mailing Address - Phone:630-279-9501
Mailing Address - Fax:
Practice Address - Street 1:1420 KENSINGTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2143
Practice Address - Country:US
Practice Address - Phone:630-449-4638
Practice Address - Fax:630-449-4638
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0008622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer