Healthcare Provider Details

I. General information

NPI: 1396244208
Provider Name (Legal Business Name): STEPHANIE ELIZABETH BARTKOWIAK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MADISON ST
OAK PARK IL
60302-4278
US

IV. Provider business mailing address

4858 N OVERLAND RD APT 81
HOBART WI
54155-9390
US

V. Phone/Fax

Practice location:
  • Phone: 708-859-8004
  • Fax:
Mailing address:
  • Phone: 248-508-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.010844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: