Healthcare Provider Details

I. General information

NPI: 1700903119
Provider Name (Legal Business Name): DOUGLAS RAYMOND STOCKER M.S., LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S RIVER ST
AURORA IL
60506-5295
US

IV. Provider business mailing address

2403 DEERFIELD DR
AURORA IL
60506-6420
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-2662
  • Fax: 630-844-3084
Mailing address:
  • Phone: 630-844-2662
  • Fax: 630-844-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: