Provider Demographics
NPI:1326471459
Name:STUKEL, HEIDI SUZANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUZANNE
Last Name:STUKEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-4331
Mailing Address - Country:US
Mailing Address - Phone:815-722-4384
Mailing Address - Fax:815-722-4390
Practice Address - Street 1:62 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4331
Practice Address - Country:US
Practice Address - Phone:815-722-4384
Practice Address - Fax:815-722-4384
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL180.008662101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216521Medicare PIN