Individual
STACEY MAE AUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
451 N LA SALLE DR, CHICAGO, IL 60654-4510
(312) 566-4478
Mailing address
2550 E FOOTHILL BLVD, PASADENA, CA 91107-3406
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
IL
Other
Enumeration date
09/02/2011
Last updated
04/12/2019
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