Provider Demographics
NPI:1871768739
Name:WEBER, STACI A (LCPC)
Entity type:Individual
Prefix:MS
First Name:STACI
Middle Name:A
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:STACI
Other - Middle Name:A
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:353 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3044
Mailing Address - Country:US
Mailing Address - Phone:847-772-8643
Mailing Address - Fax:
Practice Address - Street 1:353 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3044
Practice Address - Country:US
Practice Address - Phone:847-772-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional