Individual
DR. EDWARD STABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
205 ARCHELLE DR, CARBONDALE, IL 62901-1956
(561) 602-8129
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071.010207
IL
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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