Doctor Name: | MR. ANDREW STODOLKIEWICZ |
NPI Number: | 1578822870 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 301 E Jefferson St Macomb, IL - 614552312 |
Business Phone Number: | 3098332191 |
Business Fax Number: | 3098362118 |
Mailing Address: | 2960 Chartres St, P.o. Box 1488 LA SALLE |
State: | IL |
Postal Code: | 613011097 |
Phone Number: | 8152241610 |
Fax Number: | 8152231634 |
NPI Enumeration Date: | 05/08/2012 |
NPI Last Update Date: | 05/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |