Basic Information
| Provider Information | |||||||||
| NPI: | 1619369659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANSOM | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | CALABRESE | ||||||||
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| Credential: | ATC, OTC, SA-C | ||||||||
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| OtherLastName: | CALABRESE | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | ATC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2115 PERIWINKLE LN | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605409221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477158815 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 550 W OGDEN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | HINSDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303236116 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2015 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096003353 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 246ZX2200X | 0127115053 | IL | N | 246ZC0007X | 238000602 | IL | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.