Provider Demographics
NPI:1255010120
Name:CAREY, STEPHANIE E (CPE)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:CAREY
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8037 LAKE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1679
Mailing Address - Country:US
Mailing Address - Phone:708-910-8773
Mailing Address - Fax:
Practice Address - Street 1:114 N MARION ST STE 103
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1005
Practice Address - Country:US
Practice Address - Phone:708-665-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL220000246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist