Healthcare Provider Details

I. General information

NPI: 1922962273
Provider Name (Legal Business Name): STEPHANIE RICEDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 EVERGREEN CT
DEERFIELD IL
60015-5066
US

IV. Provider business mailing address

29 AMY DR
OSWEGO IL
60543-9707
US

V. Phone/Fax

Practice location:
  • Phone: 847-826-4119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: