Provider Demographics
NPI:1770543886
Name:LEAHY, STEPHANIE ROSE (ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSE
Last Name:LEAHY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1711
Mailing Address - Country:US
Mailing Address - Phone:847-577-9766
Mailing Address - Fax:
Practice Address - Street 1:1100 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4054
Practice Address - Country:US
Practice Address - Phone:847-718-4357
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist