Provider Demographics
NPI:1568890689
Name:STEPPIN STONE WOMENS RESOURCES CENTER
Entity Type:Organization
Organization Name:STEPPIN STONE WOMENS RESOURCES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-957-9420
Mailing Address - Street 1:1139 LEAVITT AVE
Mailing Address - Street 2:UNIT 210
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1550
Mailing Address - Country:US
Mailing Address - Phone:708-957-9420
Mailing Address - Fax:708-365-6392
Practice Address - Street 1:1139 LEAVITT AVE
Practice Address - Street 2:UNIT 210
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1550
Practice Address - Country:US
Practice Address - Phone:708-957-9420
Practice Address - Fax:708-365-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008975251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health