Provider Demographics
NPI:1467685891
Name:SPOOLSTRA, STEPHANIE LYNN (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SPOOLSTRA
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 N ILLINOIS ST
Mailing Address - Street 2:ROOM 331
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1316
Mailing Address - Country:US
Mailing Address - Phone:317-931-5110
Mailing Address - Fax:317-931-5113
Practice Address - Street 1:1700 N ILLINOIS ST
Practice Address - Street 2:ROOM 331
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1316
Practice Address - Country:US
Practice Address - Phone:317-931-5110
Practice Address - Fax:317-931-5113
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)