Provider Demographics
NPI:1467096420
Name:BOWER, STEPHANIE (LSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27293 POTOMAC COLLISON RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:IL
Mailing Address - Zip Code:61865-3143
Mailing Address - Country:US
Mailing Address - Phone:217-776-2273
Mailing Address - Fax:
Practice Address - Street 1:1101 E WINTER AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-2295
Practice Address - Country:US
Practice Address - Phone:217-651-6801
Practice Address - Fax:217-651-6802
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-03
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150104020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker