Healthcare Provider Details

I. General information

NPI: 1295508158
Provider Name (Legal Business Name): RACHAEL STEDMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 W NORTH AVE # 2A
CHICAGO IL
60647-5413
US

IV. Provider business mailing address

4846 N CLARK ST STE 100
CHICAGO IL
60640-7925
US

V. Phone/Fax

Practice location:
  • Phone: 312-574-0750
  • Fax:
Mailing address:
  • Phone: 312-574-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.021006
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: