Healthcare Provider Details

I. General information

NPI: 1295698967
Provider Name (Legal Business Name): STEPHANIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 SKOKIE BLVD
SKOKIE IL
60077-9944
US

IV. Provider business mailing address

2613 N ALBANY AVE APT 2
CHICAGO IL
60647-1648
US

V. Phone/Fax

Practice location:
  • Phone: 847-220-7232
  • Fax:
Mailing address:
  • Phone: 708-601-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.030531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: