Healthcare Provider Details

I. General information

NPI: 1104248806
Provider Name (Legal Business Name): ALEXANDER STEWART ROI L.C.P.C., N.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 FOREST AVE
WILMETTE IL
60091-1760
US

IV. Provider business mailing address

7022 EMERSON ST
MORTON GROVE IL
60053-1205
US

V. Phone/Fax

Practice location:
  • Phone: 773-965-1172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180004824
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: