MEDICARE: STACEY ILKO - HANCOCK PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6098	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194778993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY ILKO - HANCOCK PSY.D

Provider Business Mailing Address
First Line	:	221 W LIBERTY ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2217
Country	:	US
Telephone Number	:	330-722-4166
Fax Number	:	330-725-5792

Provider Business Practice Location Address
First Line	:	11925 PEARL RD STE 306A
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44136-3343
Country	:	US
Telephone Number	:	404-554-5661
Fax Number	:	330-776-5557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/29/2025

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