Provider Demographics
NPI:1518544477
Name:STEPHAN, BRETT (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:STEPHAN
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 N SANGAMON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2201
Mailing Address - Country:US
Mailing Address - Phone:773-923-3543
Mailing Address - Fax:773-232-8609
Practice Address - Street 1:159 N SANGAMON ST STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2201
Practice Address - Country:US
Practice Address - Phone:773-923-3543
Practice Address - Fax:773-232-8609
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61442753363LP0808X
OR10010368363LP0808X, 163WG0000X
IL209025957363LP0808X
IL041424649163WG0000X
WARN61442743163WG0000X
TX1048426163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice