Provider Demographics
NPI:1619225547
Name:GORBOLD, STEPHANIE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:GORBOLD
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 1:484 W BOUGHTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2478
Mailing Address - Country:US
Mailing Address - Phone:312-882-1024
Mailing Address - Fax:312-488-3663
Practice Address - Street 1:484 W BOUGHTON RD STE C
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2478
Practice Address - Country:US
Practice Address - Phone:312-882-1024
Practice Address - Fax:312-488-3663
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst