Individual
MRS. STACIE NICHOLE WOODWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2128 MIDLANDS CT, SYCAMORE, IL 60178-3199
(815) 758-0000
Mailing address
315 W CHESTER DR, MAPLE PARK, IL 60151-9193
(630) 707-7556
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
96001400
IL
Other
Enumeration date
01/06/2007
Last updated
12/29/2015
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