Individual
STACEY MARIE ISROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS/PSYC, DT
Contact information
Practice address
1799 KINGS GATE LN, CRYSTAL LAKE, IL 60014-2906
(815) 276-7786
(815) 788-1321
Mailing address
1799 KINGS GATE LN, CRYSTAL LAKE, IL 60014-2906
(815) 276-7786
(815) 788-1321
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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