=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659090025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TESSA V STERLING LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2022
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15146 16TH AVE
-----------------------------------------------------
City | MARNE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49435-9605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-776-9651
-----------------------------------------------------
Fax | 616-341-6016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 REVERE DR STE 100
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-1590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-306-1879
-----------------------------------------------------
Fax | 224-306-1878
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149.022363
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------