Jaclyn Leigh Stahl, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160.005959 Issued in IL

Practice address

101 Waukegan Rd Ste 1100
Lake Bluff, IL 60044-3012

Phone

(847) 247-2402

Fax

(847) 247-2405

NPI assigned

Jun 9, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1467832089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RAND RD STE 300",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162359",
            "telephone_number": "847-324-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WAUKEGAN RD STE 1100",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600443012",
            "telephone_number": "847-247-2402",
            "fax_number": "847-247-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHL",
        "first_name": "JACLYN",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-09",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.005959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert H Sorensen, M.D.
• Emily J Soriaga
• Dana Spehlmann
• Rachael Denise Spencer, RN
• Megan Spillane, LCSW
• Tracy Steinmetz, MSW
• Allison Elizabeth Stockfleth, LPC
• William E. Strampe, D.D.S.
• Jehu Strange, MD DABFM
• Suzanne S. Walker LLC

• Physical Therapy Assistant in Lake Bluff, IL
• Providers in Lake Bluff, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.