Individual
STEPHANIE SHADLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
304 PRAIRIE DR, DIETERICH, IL 62424-1127
(217) 925-5191
Mailing address
304 PRAIRIE DR, DIETERICH, IL 62424-1127
(217) 925-5191
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/18/2007
Last updated
07/08/2007
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