Provider Demographics
NPI:1215302039
Name:BARKEMEYER, STEPHANIE RAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RAE
Last Name:BARKEMEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:THOMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25566 W IVANHOE RD
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2407
Mailing Address - Country:US
Mailing Address - Phone:224-392-1015
Mailing Address - Fax:
Practice Address - Street 1:103 TERRA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:VOLO
Practice Address - State:IL
Practice Address - Zip Code:60020-3201
Practice Address - Country:US
Practice Address - Phone:224-392-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL149.0215771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker