Stillwater Therapy PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

STILLWATER THERAPY PLLC

Practice address

949 S Harvard Dr
Palatine, IL 60067-7028

Phone

(617) 921-6355

NPI assigned

Aug 30, 2023

Last updated

Aug 30, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Noel Widholm, LCSWNPI 1881088912

Title

Owner

Phone

(617) 921-6355

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Noel Widholm, MSW, LCSW

  • Clinical Social Worker
  • Arlington Heights, IL
  • NPI 1881088912
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1693353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1972388676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 S HARVARD DR",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600677028",
            "telephone_number": "617-921-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 S HARVARD DR",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600677028",
            "telephone_number": "617-921-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-30",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "WIDHOLM",
        "authorized_official_first_name": "NOEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-921-6355",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tristan Stewart, LCPC
• Renie Stoller-Zak, MA, LPC, NCC
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• Curtis Stratton
• Todd M Stull, LCSW
• Gerald Michael Sullivan, PSYD

• Clinical Social Worker in Palatine, IL
• Providers in Palatine, 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 Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.