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General NPI Number Information
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NPI Number | 1982361333
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Entity Type | Organization
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Legal Business Name | BLUESTEM COUNSELING, PLLC
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 6085 STRATHMOOR DR STE 1C
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City | ROCKFORD
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State | IL
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Zip | 61107-6636
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Country | US
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Telephone | 154-350-9078
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Fax | 815-435-5251
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Provider Business Mailing Address
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Address Line | 234 VALE AVE N
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City | ROCKFORD
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State | IL
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Zip | 61107-4648
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW KINDLER
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Credential | LCSW
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Telephone | 815-435-0907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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