Provider Demographics
NPI:1790115293
Name:MEYERS, STACEY MARIE (PHD, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MARIE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:PHD, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:MEYERS-PROSYNIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, PMHNP-BC
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2954
Mailing Address - Country:US
Mailing Address - Phone:312-695-5060
Mailing Address - Fax:312-695-5010
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2954
Practice Address - Country:US
Practice Address - Phone:312-695-5060
Practice Address - Fax:312-695-5010
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210777363LP0808X
IL209.021975363LP0808X
IL209021975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health