Healthcare Provider Details

I. General information

NPI: 1487720652
Provider Name (Legal Business Name): STEPHANIE LYONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DAVIS ST SUITE 160
EVANSTON IL
60201-3645
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON HOSPITAL
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-425-6400
  • Fax: 847-425-6408
Mailing address:
  • Phone: 847-570-1206
  • Fax: 847-570-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149004536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: