Individual
SIMON J STILLWAGGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3821 BARING ST, PHILADELPHIA, PA 19104-5580
(609) 489-2074
Mailing address
3821 BARING ST, PHILADELPHIA, PA 19104-5580
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225700000X
Massage Therapist
Primary
MSG015461
PA
Other
Enumeration date
10/23/2014
Last updated
04/29/2026
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