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General NPI Number Information
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NPI Number | 1396547154
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Entity Type | Individual
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Provider Name | STEPHANIE KIM LSW
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Gender | Female
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1800 NATIONS DR STE 211
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City | GURNEE
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State | IL
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Zip | 60031-9173
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Country | US
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Telephone | 224-424-4194
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Fax |
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Provider Business Mailing Address
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Address Line | 4406 EUCLID AVE APT 2C
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City | ROLLING MEADOWS
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State | IL
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Zip | 60008-1944
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Country | US
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Telephone | 773-963-3023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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