Provider Demographics
NPI:1598935504
Name:CARROLL & JO DAVIES & STEPHENSON ROE
Entity Type:Organization
Organization Name:CARROLL & JO DAVIES & STEPHENSON ROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIEFEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-947-3810
Mailing Address - Street 1:500 N. RUSH ST.
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61085-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 N RUSH ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:IL
Practice Address - Zip Code:61085-1004
Practice Address - Country:US
Practice Address - Phone:815-947-3810
Practice Address - Fax:815-947-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty