Healthcare Provider Details

I. General information

NPI: 1356822316
Provider Name (Legal Business Name): STEPHANIE L SAFFOLD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MERCY LN
AURORA IL
60506-2447
US

IV. Provider business mailing address

3204 EAGLE WAY
CHICAGO IL
60678-1032
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-7400
  • Fax:
Mailing address:
  • Phone: 630-717-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178011598
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: