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NPI Code Detail

MEDICARE: DR. STACEY WILLARD PSY.D.

MEDICARE: DR. STACEY WILLARD 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
1103TC0700XClinical PsychologistPSY.0004654CO
2103TC0700XClinical Psychologist071.009205IL

General Provider Information

NPI Number : 1750746566
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY WILLARD PSY.D.
Provider Business Mailing Address
First Line : 150 S WACKER DR STE 2400
Second Line :
City : CHICAGO
State : IL
Zip : 60606-4211
Country : US
Telephone Number : 312-798-9078
Fax Number :
Provider Business Practice Location Address
First Line : 150 S WACKER DR STE 2400
Second Line :
City : CHICAGO
State : IL
Zip : 60606-4211
Country : US
Telephone Number : 312-798-9078
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2015
Last Update Date : 03/17/2018

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