Healthcare Provider Details

I. General information

NPI: 1326898800
Provider Name (Legal Business Name): OIL DOCTOR PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 FARGO BLVD
GENEVA IL
60134-2979
US

IV. Provider business mailing address

1462 FARGO BLVD
GENEVA IL
60134-2979
US

V. Phone/Fax

Practice location:
  • Phone: 224-242-0672
  • Fax:
Mailing address:
  • Phone: 224-242-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER STELTER
Title or Position: CEO/OWNER
Credential: PSY.D.
Phone: 224-242-0672