Provider Demographics
NPI:1396547154
Name:KIM, STEPHANIE (LSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 EUCLID AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1944
Mailing Address - Country:US
Mailing Address - Phone:773-963-3023
Mailing Address - Fax:
Practice Address - Street 1:1800 NATIONS DR STE 211
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9173
Practice Address - Country:US
Practice Address - Phone:224-424-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker