Basic Information
| Provider Information | |||||||||
| NPI: | 1417459710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEJSKAL | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | LCPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STEJSKAL | ||||||||
| OtherFirstName: | JOE | ||||||||
| OtherMiddleName: | F | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | III | ||||||||
| OtherCredential: | LCPC | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 811 W JOHN ST | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605609249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305539100 | ||||||||
| FaxNumber: | 6305530167 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 W JOHN STREET | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305539100 | ||||||||
| FaxNumber: | 6305530167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2018 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180-001775 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.