Healthcare Provider Details

I. General information

NPI: 1326644485
Provider Name (Legal Business Name): REANNA RAE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD
SPRINGFIELD IL
62704-4184
US

IV. Provider business mailing address

7925 TYLER CIR UNIT D
MERRILLVILLE IN
46410-5480
US

V. Phone/Fax

Practice location:
  • Phone: 312-241-3761
  • Fax:
Mailing address:
  • Phone: 312-600-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.015919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: