Provider Demographics
NPI:1235408410
Name:WARD, STEFANIE RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:RAE
Last Name:WARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 BROOKDALE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2771
Mailing Address - Country:US
Mailing Address - Phone:630-717-9408
Mailing Address - Fax:630-778-9490
Practice Address - Street 1:1935 BROOKDALE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2771
Practice Address - Country:US
Practice Address - Phone:630-717-9408
Practice Address - Fax:630-778-9490
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist