Provider Demographics
NPI:1952773319
Name:ESCOBAR, STEPHANIE (CADC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HERBERT DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-1431
Mailing Address - Country:US
Mailing Address - Phone:847-372-6771
Mailing Address - Fax:
Practice Address - Street 1:1113 W GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-4908
Practice Address - Country:US
Practice Address - Phone:847-244-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30650101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)