Stacey Lynn Fredericks

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.025334 Issued in IL

Practice address

4700 W 95TH St Ste 205
Oak Lawn, IL 60453-2574

Phone

(708) 684-7999

NPI assigned

Oct 2, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1023360989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 W 95TH ST STE 205",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532574",
            "telephone_number": "708-684-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W 95TH ST STE 205",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532574",
            "telephone_number": "708-684-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-02",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.025334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David J Fralinger
• Michael W Frank, MD
• Noel G Frank, DPM
• Erin E Frazer, M.D.
• Kristina Frazier
• John Fredricksen, DDS
• Ryan Leonard Freedman, M.D.
• Ashley Rose Frias, MS, RD, LDN
• Kathleen Patricia Fricano
• Kristine Friend, RN

• Clinical Social Worker in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.