Provider Demographics
NPI:1376726794
Name:REEDER, STACEY LANE (MSSA, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LANE
Last Name:REEDER
Suffix:
Gender:F
Credentials:MSSA, LCSW
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:LANE
Other - Last Name:SANDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 E QUEENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2985
Mailing Address - Country:US
Mailing Address - Phone:309-263-5565
Mailing Address - Fax:
Practice Address - Street 1:75 E QUEENWOOD RD
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2985
Practice Address - Country:US
Practice Address - Phone:309-263-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical