Active NPI
Stephanie L Roth, LCPC
- Professional Counselor
- Chicago, IL
National Provider Identifier
1720254857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.006723
- Practice address
- 5710 N Broadway St
Chicago, IL 60660-4302 - Phone
- (773) 728-1000
- NPI assigned
- May 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.006723 | IL | Primary |
Addresses
Primary practice location
5710 N Broadway St
Chicago, IL 60660-4302
Mailing address
5710 N Broadway St
Chicago, IL 60660-4302
Phone (773) 728-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180.006723 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.006723 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1720254857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5710 N BROADWAY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606604302",
"telephone_number": "773-728-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5710 N BROADWAY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606604302",
"telephone_number": "773-728-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "STEPHANIE",
"middle_name": "L",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-08",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.006723",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "180.006723",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.