Provider Demographics
NPI:1104817600
Name:LODA, STEPHANIE L (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:LODA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1654
Mailing Address - Country:US
Mailing Address - Phone:847-830-9512
Mailing Address - Fax:847-368-0847
Practice Address - Street 1:2 S PATTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1654
Practice Address - Country:US
Practice Address - Phone:847-830-9512
Practice Address - Fax:847-368-0847
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0109821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL780778000OtherMAGELLAN
IL0001634867OtherBLUE CROSS BLUE SHIELD
K14014Medicare UPIN
IL780778000OtherMAGELLAN