Provider Demographics
NPI:1215358528
Name:STELIGA-PHILLIPS, ANDREA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:STELIGA-PHILLIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2680
Mailing Address - Country:US
Mailing Address - Phone:309-255-6839
Mailing Address - Fax:
Practice Address - Street 1:8 S MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2680
Practice Address - Country:US
Practice Address - Phone:309-255-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-05
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008219103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist