Provider Demographics
NPI:1629498746
Name:SKOWRONSKI, STACEY (PHD, LCSW, CST)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SKOWRONSKI
Suffix:
Gender:F
Credentials:PHD, LCSW, CST
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:NADELHOFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3166 N LINCOLN AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3119
Mailing Address - Country:US
Mailing Address - Phone:708-275-5925
Mailing Address - Fax:
Practice Address - Street 1:3166 N LINCOLN AVE STE 217
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:708-275-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490163671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical