Provider Demographics
NPI:1114281870
Name:STEPHANIE WIESE
Entity Type:Organization
Organization Name:STEPHANIE WIESE
Other - Org Name:FOX BEND COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-818-7899
Mailing Address - Street 1:161 SPRINGBROOK TRL S
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-4016
Mailing Address - Country:US
Mailing Address - Phone:630-818-7899
Mailing Address - Fax:
Practice Address - Street 1:123 W WASHINGTON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8214
Practice Address - Country:US
Practice Address - Phone:630-818-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty