Individual
RICHELLE STACKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1321 E 55TH ST, CHICAGO, IL 60615-5301
(773) 217-8415
Mailing address
1321 E 55TH ST, CHICAGO, IL 60615-5301
(773) 288-9101
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007745
IL
Other
Enumeration date
04/17/2019
Last updated
04/23/2019
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