MEDICARE: STILLWATER HEALTH PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1891642179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILLWATER HEALTH PLLC

Provider Business Mailing Address
First Line	:	3256 W POTOMAC AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2411
Country	:	US
Telephone Number	:	708-280-6164
Fax Number	:

Provider Business Practice Location Address
First Line	:	3256 W POTOMAC AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2411
Country	:	US
Telephone Number	:	708-280-6164
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLLE DERRADJI
Credential	:	PMHNP-BC
Telephone Number	:	708-280-6164

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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Directions to “STILLWATER HEALTH PLLC ” Practice Location

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