Provider Demographics
NPI:1760369623
Name:STACEY M FEELEY LLC
Entity type:Organization
Organization Name:STACEY M FEELEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-633-3692
Mailing Address - Street 1:305 REBECCA RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-4975
Mailing Address - Country:US
Mailing Address - Phone:815-514-0145
Mailing Address - Fax:815-595-4652
Practice Address - Street 1:1002 N 129TH INFANTRY DR STE F
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3109
Practice Address - Country:US
Practice Address - Phone:815-514-0145
Practice Address - Fax:815-595-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty