Malm, Stacy

Malm, Stacy is an individual health care provider with primary practice located at 3401 N Central Ave , Chicago IL 60634-4426. She recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as her primary health care specialty. Malm, Stacy can be contacted via phone (773) 286-8822.

Contact Information

Primary practice address
3401 N Central Ave Chicago IL 60634-4426
Phone: (773) 286-8822
Fax: (773) 824-4997
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X Illinois

Profile Details

NPI number 1104878008
LBN Legal business name Malm, Stacy
Credentials LCPC
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated Nov 29th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104878008 NPPES
Illinois Other 01635515 BC#

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