Provider Demographics
NPI:1154002277
Name:SAUNDERS, STACYE ALLINE
Entity type:Individual
Prefix:
First Name:STACYE
Middle Name:ALLINE
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1544
Mailing Address - Country:US
Mailing Address - Phone:618-203-1475
Mailing Address - Fax:
Practice Address - Street 1:6127 S UNIVERSITY AVE STE 1148
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-5894
Practice Address - Country:US
Practice Address - Phone:312-857-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health