Provider Demographics
NPI:1083288468
Name:CHRISTOPHERSON, STEPHEN (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 ELM PL STE 7
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1458
Mailing Address - Country:US
Mailing Address - Phone:815-872-2943
Mailing Address - Fax:
Practice Address - Street 1:535 ELM PL STE 7
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1458
Practice Address - Country:US
Practice Address - Phone:815-872-2943
Practice Address - Fax:815-915-8756
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490231991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical