MEDICARE: STEPHANIE ESTELL WOLLERT MA, LPC

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	178014820	IL

General Provider Information

NPI Number	:	1679137582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ESTELL WOLLERT MA, LPC

Provider Business Mailing Address
First Line	:	3221 GRAFTON LN
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-7009
Country	:	US
Telephone Number	:	815-721-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2272 95TH ST STE 305
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8944
Country	:	US
Telephone Number	:	630-753-9800
Fax Number	:

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	08/16/2024

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