Provider Demographics
NPI:1457472987
Name:STANISH, LINDA ANN
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:STANISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1743
Mailing Address - Country:US
Mailing Address - Phone:630-310-9148
Mailing Address - Fax:630-529-1386
Practice Address - Street 1:210 CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1743
Practice Address - Country:US
Practice Address - Phone:630-310-9148
Practice Address - Fax:630-529-1386
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILLS49550299P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist