Basic Information
| Provider Information | |||||||||
| NPI: | 1023021243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAHNKE | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | FRANCES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4711 W. GOLF RD. | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476793079 | ||||||||
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| Practice Location | |||||||||
| Address1: | 675 W NORTH AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601601634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086817309 | ||||||||
| FaxNumber: | 7086817683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | IL | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.