Provider Demographics
NPI:1912231101
Name:STEEN, VICKY (LMT, CMMP)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:STEEN
Suffix:
Gender:F
Credentials:LMT, CMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 CHRISTOPHER CT E
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5145
Mailing Address - Country:US
Mailing Address - Phone:815-609-8546
Mailing Address - Fax:
Practice Address - Street 1:4700 GILBERT AVE STE 45
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1667
Practice Address - Country:US
Practice Address - Phone:708-784-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227009368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist