Provider Demographics
NPI:1265631386
Name:RICE, STEPHANIE MICHELE (EDD, CERT AVT)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:RICE
Suffix:
Gender:F
Credentials:EDD, CERT AVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 67TH ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3019
Mailing Address - Country:US
Mailing Address - Phone:630-971-2304
Mailing Address - Fax:
Practice Address - Street 1:609 67TH ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3019
Practice Address - Country:US
Practice Address - Phone:630-971-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist