MEDICARE: STEPHANIE LAFONTAINE MA, LPC

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
1	101YP2500X	Professional Counselor	178012852	IL

General Provider Information

NPI Number	:	1912471129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LAFONTAINE MA, LPC

Provider Business Mailing Address
First Line	:	4318 W CRYSTAL LAKE RD STE L
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4250
Country	:	US
Telephone Number	:	815-331-8381
Fax Number	:	815-331-8362

Provider Business Practice Location Address
First Line	:	4318 W CRYSTAL LAKE ROAD
Second Line	:	SUITE L
City	:	MCHENRY
State	:	IL
Zip	:	60050-4250
Country	:	US
Telephone Number	:	815-331-8381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	01/22/2019

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