Provider Demographics
NPI:1205331386
Name:QUATTROCKI, STEPHANIE WILLMS (MA, LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WILLMS
Last Name:QUATTROCKI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:LEE
Other - Last Name:WILLMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4021
Mailing Address - Country:US
Mailing Address - Phone:773-763-3433
Mailing Address - Fax:
Practice Address - Street 1:5500 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4021
Practice Address - Country:US
Practice Address - Phone:773-763-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
178013472101YP2500X
IL178013472101YP2500X
IL178913472.101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional