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STEPHANIE CLARK LCPC
NPI 1760969588
Counselor - Professional in Chicago, IL

Active since July 24, 2018PECOS Enrolled
5453 W DIVERSEY AVE, CHICAGO, IL 60639(773) 564-9070 Get Directions Write a Review

NPPES record last updated: July 24, 2018. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Stephanie Clark Lcpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STEPHANIE CLARK LCPC (NPI 1760969588) is an individual professional provider in Chicago, Illinois, licensed in Illinois (180.010831) and active in the NPI registry since July 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1760969588
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameSTEPHANIE CLARKCredential: LCPC
Location Address5453 W DIVERSEY AVEChicago, IL 60639-1413
Mailing Address5453 W Diversey AveChicago, IL 60639-1413 · (773) 564-9070
Phone(773) 564-9070
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateJuly 24, 2018
✔ NPI 1760969588 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in IL · 180.010831
5453 W DIVERSEY AVE, Chicago, IL 60639
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stephanie Clark Lcpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1254824881
PECOS Enrollment IDI20251203000614
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Stephanie Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Rush University Medical Center
6.3 mi
Diagnostic Radiology
1620 W HARRISON ST
Chicago, IL 60612
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: Rush University Medical Group
  • 2,169 clinicians in this Medicare group
NPI 1184269425 (312) 563-4270

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RINCON FAMILY SERVICES
Clinic/Center (Mental Health (Including Community Mental Health Center))
5453 W DIVERSEY AVE
CHICAGO, IL 60639
Cook County (773) 564-9070
RINCON FAMILY SERVICES
Clinic/Center (Rehabilitation, Substance Use Disorder)
5453 W DIVERSEY AVE
CHICAGO, IL 60639
Cook County (888) 215-0513
RINCON FAMILY SERVICES
Clinic/Center (Mental Health (Including Community Mental Health Center))
5453 W DIVERSEY AVE
CHICAGO, IL 60639
Cook County (888) 215-0513

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stephanie Clark's NPI number?

The NPI number for Stephanie Clark is 1760969588. It was assigned to this individual provider in the NPPES registry on July 24, 2018.

Where is Stephanie Clark located?

Stephanie Clark practices at 5453 W Diversey Ave, Chicago, IL 60639. The listed phone number is (773) 564-9070.

What is Stephanie Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Stephanie Clark enrolled in Medicare?

Yes. Stephanie Clark is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Stephanie Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Stephanie Clark reassigns Medicare benefits to Rush University Medical Center (Chicago, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stephanie Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Stephanie Clark was last updated on July 24, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.