Individual
STACIE JUNE MARIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3046 N KENMORE AVE, CHICAGO, IL 60657-9094
(331) 457-1325
Mailing address
3046 N KENMORE AVE, CHICAGO, IL 60657-9094
(331) 457-1325
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/24/2020
Last updated
01/24/2020
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