Provider Demographics
NPI:1528577749
Name:STIEMKE, JOHN W (CADC, ACRPS, NCRC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:STIEMKE
Suffix:
Gender:M
Credentials:CADC, ACRPS, NCRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4153
Mailing Address - Country:US
Mailing Address - Phone:312-304-1154
Mailing Address - Fax:
Practice Address - Street 1:700 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4350
Practice Address - Country:US
Practice Address - Phone:312-573-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)