Individual
STACY MALM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
3401 N CENTRAL AVE, CHICAGO, IL 60634-4426
(773) 286-8822
(773) 824-4997
Mailing address
3401 N CENTRAL AVE, CHICAGO, IL 60634-4426
(773) 286-8822
(773) 824-4997
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635515
BC#
IL
Enumeration date
05/17/2006
Last updated
11/29/2007
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