Provider Demographics
NPI:1861662298
Name:SIMEK, STACY J (MS, DT-H, LSLS CERT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:J
Last Name:SIMEK
Suffix:
Gender:F
Credentials:MS, DT-H, LSLS CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 OAK MEADOW CT
Mailing Address - Street 2:B1
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2276
Mailing Address - Country:US
Mailing Address - Phone:630-532-3740
Mailing Address - Fax:
Practice Address - Street 1:324 OAK MEADOW CT
Practice Address - Street 2:B1
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-2276
Practice Address - Country:US
Practice Address - Phone:630-532-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist