Provider Demographics
NPI:1881844934
Name:WALSH, STEPHANIE SUZANNE (CST/CFA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 MILLSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8279
Mailing Address - Country:US
Mailing Address - Phone:815-786-5153
Mailing Address - Fax:
Practice Address - Street 1:333 MILLSTREAM LN
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8279
Practice Address - Country:US
Practice Address - Phone:815-786-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant