Individual
STEPHANIE MCCONVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3145 W PRATT BLVD, CHICAGO, IL 60645-4125
(773) 467-3744
Mailing address
3145 W PRATT BLVD, CHICAGO, IL 60645-4125
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.009722
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362167757001
—
IL
Enumeration date
02/12/2018
Last updated
02/12/2018
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