Provider Demographics
NPI:1316539885
Name:WEILAND, STEPHANIE THERESA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:THERESA
Last Name:WEILAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 SKOKIE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1384
Mailing Address - Country:US
Mailing Address - Phone:847-440-4874
Mailing Address - Fax:847-278-5419
Practice Address - Street 1:9711 SKOKIE BLVD STE H
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1384
Practice Address - Country:US
Practice Address - Phone:847-440-4874
Practice Address - Fax:847-278-5419
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0208421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical