Provider Demographics
NPI:1164032900
Name:DOWELL, STEPHANIE LYNN WOLF (LSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN WOLF
Last Name:DOWELL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:DOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 S 5TH AVE BLDG 228
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-3030
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:708-202-4954
Practice Address - Street 1:5000 S 5TH AVE BLDG 228
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-4954
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR61152850OtherFEDERAL EMPLOYEE BLUE CROSS BLUE SHIELD