Provider Demographics
NPI:1588815385
Name:RABIN DICKSON, STEPHANIE R
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:RABIN DICKSON
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 1:1019 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3548
Mailing Address - Country:US
Mailing Address - Phone:773-531-8569
Mailing Address - Fax:
Practice Address - Street 1:1019 MAYFAIR DR
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3548
Practice Address - Country:US
Practice Address - Phone:773-531-8569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist