Healthcare Provider Details

I. General information

NPI: 1497187827
Provider Name (Legal Business Name): STEPHANIE CALATO COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 WIND POINT DR
ROCKFORD IL
61108-3721
US

IV. Provider business mailing address

4615 E STATE ST SUITE 130
ROCKFORD IL
61108-2100
US

V. Phone/Fax

Practice location:
  • Phone: 815-218-7964
  • Fax: 815-391-8004
Mailing address:
  • Phone: 815-218-7964
  • Fax: 815-391-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180.007094
License Number StateIL

VIII. Authorized Official

Name: STEPHANIE CALATO
Title or Position: COUNSELOR/OWNER
Credential: LCPC
Phone: 815-218-7964