Healthcare Provider Details

I. General information

NPI: 1417459710
Provider Name (Legal Business Name): JOSEPH F STEJSKAL III LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOE F STEJSKAL III LCPC

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W JOHN STREET
YORKVILLE IL
60560
US

IV. Provider business mailing address

811 W JOHN ST
YORKVILLE IL
60560-9249
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-9100
  • Fax: 630-553-0167
Mailing address:
  • Phone: 630-553-9100
  • Fax: 630-553-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-001775
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: