Provider Demographics
NPI:1023342565
Name:MICHAEL L. STOLLER & ASSOCIATES, LLC
Entity type:Organization
Organization Name:MICHAEL L. STOLLER & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:773-934-8721
Mailing Address - Street 1:208 PARKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8211
Mailing Address - Country:US
Mailing Address - Phone:773-934-8721
Mailing Address - Fax:
Practice Address - Street 1:633 SKOKIE BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2858
Practice Address - Country:US
Practice Address - Phone:773-934-8721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0129691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty