Individual
CONNIE S STANISLAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
114 W ROCKLAND RD, LIBERTYVILLE, IL 60060
(847) 816-9180
(847) 816-9183
Mailing address
114 W ROCKLAND RD, LIBERTYVILLE, IL 60060
(847) 816-9180
(847) 816-9183
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295897148
NATIONAL ID GROUP
IL
Enumeration date
03/20/2007
Last updated
07/08/2007
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