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Individual

DR. JONATHAN WILLIAM THOMAS-STAGG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LICENSED PSYCHOLOGIS

Contact information

Practice address
701 DEVONSHIRE DR, CHAMPAIGN, IL 61820-7337
(309) 657-4904
Mailing address
701 DEVONSHIRE DR, C-53, CHAMPAIGN, IL 61820-7337
(309) 657-4904

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071008196
IL

Other

Enumeration date
12/14/2011
Last updated
02/19/2018
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