Provider Demographics
NPI:1760067623
Name:TAPPAN, STEPHANIE L (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:TAPPAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6N165 CLYDE CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-6712
Mailing Address - Country:US
Mailing Address - Phone:630-606-0152
Mailing Address - Fax:773-966-1445
Practice Address - Street 1:1595 WELD RD STE 5
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5896
Practice Address - Country:US
Practice Address - Phone:630-606-0152
Practice Address - Fax:773-966-1445
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical