Provider Demographics
NPI:1114368263
Name:BAGWELL, STEPHANIE K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:K
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 22ND ST SW
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-7068
Mailing Address - Country:US
Mailing Address - Phone:773-559-8172
Mailing Address - Fax:
Practice Address - Street 1:1256 22ND ST SW
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-7068
Practice Address - Country:US
Practice Address - Phone:720-507-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004599103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical