Healthcare Provider Details

I. General information

NPI: 1588666093
Provider Name (Legal Business Name): ROSEMARIE STEFANIW-GOTTLIEB PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date: 05/16/2025
Reactivation Date: 06/11/2025

III. Provider practice location address

100 N ATKINSON RD STE 106
GRAYSLAKE IL
60030-7805
US

IV. Provider business mailing address

1710 WALNUT CT
SPRING GROVE IL
60081-8074
US

V. Phone/Fax

Practice location:
  • Phone: 888-211-8171
  • Fax: 847-316-9797
Mailing address:
  • Phone: 847-899-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.003947
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277.003947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: