Provider Demographics
NPI:1205582095
Name:KILPER, STEPHANIE (LCPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KILPER
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 1:1802 W BERTEAU AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6182
Mailing Address - Country:US
Mailing Address - Phone:708-580-8848
Mailing Address - Fax:
Practice Address - Street 1:1802 W BERTEAU AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6182
Practice Address - Country:US
Practice Address - Phone:708-580-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016691101YP2500X
ILBC-DMT-1408225600000X
IL180015157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist