Provider Demographics
NPI:1952750507
Name:STADLMAN, SAMANTHA (LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STADLMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 W THOME AVE
Mailing Address - Street 2:GDN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1814
Mailing Address - Country:US
Mailing Address - Phone:847-456-7925
Mailing Address - Fax:
Practice Address - Street 1:872 S MILWAUKEE AVE
Practice Address - Street 2:#273
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3227
Practice Address - Country:US
Practice Address - Phone:847-615-8696
Practice Address - Fax:847-615-8656
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011793101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1891028247OtherEQUESTRIAN CONNECTION