Basic Information
| Provider Information | |||||||||
| NPI: | 1801459623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | STACEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7410264 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606740264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159426323 | ||||||||
| FaxNumber: | 7792105541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1239 WINDHAM PKWY | ||||||||
| Address2: | |||||||||
| City: | ROMEOVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604461608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159426323 | ||||||||
| FaxNumber: | 7792105541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 02/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.020990 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.