Doctor Name: | DR. STACEY PELTON |
NPI Number: | 1063676427 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 071.005848 |
Business Practice Address: | 1920 Thoreau Dr N Suite 151 Schaumburg, IL - 601734176 |
Business Phone Number: | 8473031880 |
Business Fax Number: | 8473031881 |
Mailing Address: | 1920 Thoreau Dr N, Suite 151 SCHAUMBURG |
State: | IL |
Postal Code: | 601734176 |
Phone Number: | 8473031880 |
Fax Number: | 8473031881 |
NPI Enumeration Date: | 07/15/2008 |
NPI Last Update Date: | 02/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071.005848 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |