Provider Demographics
NPI:1699024182
Name:BECK, STEPHANIE ANN (MA, MED)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:BECK
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 W LUNT AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2734
Mailing Address - Country:US
Mailing Address - Phone:262-422-5592
Mailing Address - Fax:
Practice Address - Street 1:1619 W LUNT AVE
Practice Address - Street 2:APT 2B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2734
Practice Address - Country:US
Practice Address - Phone:262-422-5592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL178.012117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health