Provider Demographics
NPI:1568548634
Name:STALLMAN, JANET RAE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:RAE
Last Name:STALLMAN
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 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 6108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-680-8701
Mailing Address - Fax:773-784-8906
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 6108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-680-8701
Practice Address - Fax:773-784-8906
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635287OtherBLUE CROSS/BLUE SHIELD PR