Individual
STEFANIE MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY. D.
Contact information
Practice address
4305 N LINCOLN AVE, OFFICE J, CHICAGO, IL 60618-1711
(773) 316-1488
Mailing address
4305 N LINCOLN AVE, OFFICE J, CHICAGO, IL 60618-1711
(773) 316-1488
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-006622
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071-006622
STATE LICENSE NUMBER
IL
Enumeration date
12/11/2006
Last updated
07/15/2011
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