Provider Demographics
NPI:1598410177
Name:WEIR, STEPHANIE K (LCPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:WEIR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N PROSPECT RD STE A2D
Mailing Address - Street 2:
Mailing Address - City:PEORIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61616-6473
Mailing Address - Country:US
Mailing Address - Phone:309-431-1526
Mailing Address - Fax:
Practice Address - Street 1:4700 N PROSPECT RD STE A2D
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-6473
Practice Address - Country:US
Practice Address - Phone:309-431-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional