Healthcare Provider Details

I. General information

NPI: 1689977043
Provider Name (Legal Business Name): LISA A STEAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E DIAMOND ST
BYRON IL
61010-9372
US

IV. Provider business mailing address

115 E DIAMOND ST
BYRON IL
61010-9372
US

V. Phone/Fax

Practice location:
  • Phone: 309-333-1180
  • Fax: 815-234-5580
Mailing address:
  • Phone: 309-333-1180
  • Fax: 815-234-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014439
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: