Provider Demographics
NPI:1134117310
Name:STEVENSON, JANET Y (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:Y
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:YELLOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-6401
Mailing Address - Fax:505-368-6431
Practice Address - Street 1:US HWY 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6401
Practice Address - Fax:505-368-6431
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI1141104100000X
NMT-0117041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ335201Medicaid
NM01608517Medicaid
CO87901846Medicaid
AZ335201Medicaid
320059Medicare Oscar/Certification
P56729Medicare UPIN