MEDICARE: ELIZABETH STACHULSKI

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	180.010907	IL

General Provider Information

NPI Number	:	1932581568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH STACHULSKI

Provider Business Mailing Address
First Line	:	5703 N NEWARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5703 N NEWARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3140
Country	:	US
Telephone Number	:	757-647-0477
Fax Number	:

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

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	03/29/2020

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