Provider Demographics
NPI:1942381140
Name:THORN, STACEY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:THORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:FRUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4255 N WHIPPLE ST
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2515
Mailing Address - Country:US
Mailing Address - Phone:312-493-1518
Mailing Address - Fax:
Practice Address - Street 1:2300 N. CHILDREN'S PLAZA, BOX 10
Practice Address - Street 2:CHILDREN'S MEMORIAL HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4104
Practice Address - Fax:773-880-8109
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490112111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical