1417459710 NPI number — MR. JOSEPH F STEJSKAL III LCPC

Table of content: MR. JOSEPH F STEJSKAL III LCPC (NPI 1417459710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417459710 NPI number — MR. JOSEPH F STEJSKAL III LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEJSKAL
Provider First Name:
JOSEPH
Provider Middle Name:
F
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
LCPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEJSKAL
Provider Other First Name:
JOE
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417459710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 W JOHN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60560-9249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-553-9100
Provider Business Mailing Address Fax Number:
630-553-0167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 W JOHN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORKVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-553-9100
Provider Business Practice Location Address Fax Number:
630-553-0167
Provider Enumeration Date:
03/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180-001775 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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