Provider Demographics
NPI:1114011236
Name:STUMME, SANDRA (MA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:STUMME
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 N KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5922
Mailing Address - Country:US
Mailing Address - Phone:773-777-3907
Mailing Address - Fax:
Practice Address - Street 1:3249 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4360
Practice Address - Country:US
Practice Address - Phone:773-371-3703
Practice Address - Fax:773-282-6698
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical