Provider Demographics
NPI:1326343567
Name:WEBER, STEPHANIE LEE (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 S BATAVIA AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2921
Mailing Address - Country:US
Mailing Address - Phone:630-482-9699
Mailing Address - Fax:630-482-9669
Practice Address - Street 1:528 S BATAVIA AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2921
Practice Address - Country:US
Practice Address - Phone:630-482-9699
Practice Address - Fax:630-482-9669
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health