Provider Demographics
NPI:1629567185
Name:LEM, STEFANIE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:ANN
Last Name:LEM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST STE P510
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3492
Mailing Address - Country:US
Mailing Address - Phone:815-935-0750
Mailing Address - Fax:815-937-8797
Practice Address - Street 1:375 N WALL ST STE P510
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3492
Practice Address - Country:US
Practice Address - Phone:815-935-0750
Practice Address - Fax:815-937-8797
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical