Provider Demographics
NPI:1891215158
Name:STEFANIUK, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:STEFANIUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 ORIOLE LN
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-2760
Mailing Address - Country:US
Mailing Address - Phone:847-544-8064
Mailing Address - Fax:
Practice Address - Street 1:CLINICAL CARE CONSULTANTS
Practice Address - Street 2:1642 W. COLONIAL PARKWAY
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067
Practice Address - Country:US
Practice Address - Phone:847-749-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health