Healthcare Provider Details

I. General information

NPI: 1629498746
Provider Name (Legal Business Name): STACEY SKOWRONSKI PHD, LCSW, CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY NADELHOFFER LCSW

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 N LINCOLN AVE STE 217
CHICAGO IL
60657-3119
US

IV. Provider business mailing address

3166 N LINCOLN AVE STE 217
CHICAGO IL
60657-3119
US

V. Phone/Fax

Practice location:
  • Phone: 708-275-5925
  • Fax:
Mailing address:
  • Phone: 708-275-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: