Provider Demographics
NPI:1134427263
Name:HILLENBURG, STACY KATHLEEN
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:KATHLEEN
Last Name:HILLENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:KATHLEEN
Other - Last Name:DORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 LILY CT
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3263
Mailing Address - Country:US
Mailing Address - Phone:773-655-5609
Mailing Address - Fax:
Practice Address - Street 1:11 LILY CT
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3263
Practice Address - Country:US
Practice Address - Phone:773-655-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist