MEDICARE: STEPHANIE LIEBL

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	101YP2500X	Professional Counselor	178.016137	IL

General Provider Information

NPI Number	:	1518638279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LIEBL

Provider Business Mailing Address
First Line	:	4422 N RAVENSWOOD AVE
Second Line	:	PMB 23
City	:	CHICAGO
State	:	IL
Zip	:	60640-5803
Country	:	US
Telephone Number	:	872-246-0466
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 N RAVENSWOOD AVE
Second Line	:	PMB 23
City	:	CHICAGO
State	:	IL
Zip	:	60640-5803
Country	:	US
Telephone Number	:	872-246-0466
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	12/01/2025

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Directions to “ STEPHANIE LIEBL ” Practice Location

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