Provider Demographics
NPI:1093440935
Name:STOHR, SITHARA
Entity Type:Individual
Prefix:
First Name:SITHARA
Middle Name:
Last Name:STOHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SITHARA
Other - Middle Name:
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 W WASHINGTON ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3219
Mailing Address - Country:US
Mailing Address - Phone:773-980-9679
Mailing Address - Fax:
Practice Address - Street 1:77 W WASHINGTON ST STE 1500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3219
Practice Address - Country:US
Practice Address - Phone:773-980-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL150.1076561041C0700X
IL149.0257441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker