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NPI Code Detail

MEDICARE: DR. STEPHANIE R COCKRELL PHD

MEDICARE: DR. STEPHANIE R COCKRELL PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker150113535IL
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1619825387
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE R COCKRELL PHD
Provider Business Mailing Address
First Line : 1803 PHILO RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6015
Country : US
Telephone Number : 773-340-2465
Fax Number :
Provider Business Practice Location Address
First Line : 1803 PHILO RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6015
Country : US
Telephone Number : 773-340-2465
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/30/2026

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