Provider Demographics
NPI:1194367995
Name:SIMONS, STEPHANIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SIMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 GATEWAY LOOP STE 140
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7722
Mailing Address - Country:US
Mailing Address - Phone:541-654-8107
Mailing Address - Fax:
Practice Address - Street 1:1126 GATEWAY LOOP STE 140
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7722
Practice Address - Country:US
Practice Address - Phone:541-654-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL76831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical