Healthcare Provider Details

I. General information

NPI: 1780379784
Provider Name (Legal Business Name): STACEE LEIGH-ANNE REICHERZER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 W GRACE ST APT 1508
CHICAGO IL
60613-5771
US

IV. Provider business mailing address

828 W GRACE ST APT 1508
CHICAGO IL
60613-5771
US

V. Phone/Fax

Practice location:
  • Phone: 312-841-2205
  • Fax:
Mailing address:
  • Phone: 312-841-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number20122
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20122
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: