Provider Demographics
NPI:1336222454
Name:STAMPER, MARTHA SUE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:SUE
Last Name:STAMPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4989 RFD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8227
Mailing Address - Country:US
Mailing Address - Phone:847-438-3272
Mailing Address - Fax:847-519-0522
Practice Address - Street 1:1340 REMINGTON RD STE T
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4821
Practice Address - Country:US
Practice Address - Phone:847-519-0520
Practice Address - Fax:847-519-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical