Provider Demographics
NPI:1972080935
Name:STOKLOSA-CALDWELL, VICTORIA DAWN (LCPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DAWN
Last Name:STOKLOSA-CALDWELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20550 N LAGRANGE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1273
Mailing Address - Country:US
Mailing Address - Phone:888-428-7890
Mailing Address - Fax:847-428-7891
Practice Address - Street 1:20550 S LAGRANGE RD STE 105
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1273
Practice Address - Country:US
Practice Address - Phone:847-868-3435
Practice Address - Fax:847-859-5885
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
IL178014222101YM0800X
IL180.015042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid