Provider Demographics
NPI:1356172019
Name:STONE, JACQUELINE N/A (MCAT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:N/A
Last Name:STONE
Suffix:
Gender:F
Credentials:MCAT
Other - Prefix:MRS
Other - First Name:JACQUIE
Other - Middle Name:N/A
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCAT
Mailing Address - Street 1:2513 LEACH DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8907
Mailing Address - Country:US
Mailing Address - Phone:630-721-0055
Mailing Address - Fax:
Practice Address - Street 1:700 E OGDEN AVE STE 304
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5554
Practice Address - Country:US
Practice Address - Phone:630-828-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty