Provider Demographics
NPI:1417184631
Name:STOPA, JOANNA DOMINIKA (MA)
Entity Type:Individual
Prefix:MISS
First Name:JOANNA
Middle Name:DOMINIKA
Last Name:STOPA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 W JEFFERSON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5262
Mailing Address - Country:US
Mailing Address - Phone:815-741-5531
Mailing Address - Fax:815-741-5537
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-741-5531
Practice Address - Fax:815-741-5537
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst