Individual
STEPHANI ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
907 BANCROFT PL, BELVIDERE, IL 61008-5040
(630) 308-2389
(815) 544-5581
Mailing address
907 BANCROFT PL, BELVIDERE, IL 61008-5040
(630) 308-2389
(815) 544-5581
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
471661
IL
Other
Enumeration date
07/16/2012
Last updated
07/16/2012
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