Individual
MRS. STACEY WEATHERS-CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
650 INGRAHAM AVE, CALUMET CITY, IL 60409-4236
(708) 546-8208
Mailing address
PO BOX 647, LANSING, IL 60438-0647
(708) 546-8208
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
08/17/2020
Last updated
08/17/2020
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