Healthcare Provider Details

I. General information

NPI: 1003529736
Provider Name (Legal Business Name): ALEXANDRA MARIE STAUBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 W DIVISION ST
COAL CITY IL
60416-1581
US

IV. Provider business mailing address

609 WALLACE AVE
MORRIS IL
60450-1332
US

V. Phone/Fax

Practice location:
  • Phone: 630-915-8758
  • Fax:
Mailing address:
  • Phone: 630-915-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029231
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: