Healthcare Provider Details

I. General information

NPI: 1205582095
Provider Name (Legal Business Name): STEPHANIE KILPER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W BERTEAU AVE STE 205
CHICAGO IL
60613-6182
US

IV. Provider business mailing address

1802 W BERTEAU AVE STE 205
CHICAGO IL
60613-6182
US

V. Phone/Fax

Practice location:
  • Phone: 708-580-8848
  • Fax:
Mailing address:
  • Phone: 708-580-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178016691
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberBC-DMT-1408
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180015157
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: