Provider Demographics
NPI:1255300117
Name:STIFF, KENNETH A (ATC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:STIFF
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 1:2904 SOUTH CT
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1757
Mailing Address - Country:US
Mailing Address - Phone:847-394-3492
Mailing Address - Fax:
Practice Address - Street 1:500 W ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-4272
Practice Address - Country:US
Practice Address - Phone:847-718-4412
Practice Address - Fax:847-718-4417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL96000134225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist