Provider Demographics
NPI:1265449300
Name:STOUGH, JOAN BARTEL (BS, MA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BARTEL
Last Name:STOUGH
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29W342 OAK LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5940
Mailing Address - Country:US
Mailing Address - Phone:630-231-6483
Mailing Address - Fax:
Practice Address - Street 1:1N121 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2019
Practice Address - Country:US
Practice Address - Phone:630-231-6483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist