Provider Demographics
NPI:1518555150
Name:VAN HOUSEN, STEPHANIE LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:VAN HOUSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STEVIE
Other - Middle Name:
Other - Last Name:VAN HOUSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1150 5TH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2933
Mailing Address - Country:US
Mailing Address - Phone:319-804-9312
Mailing Address - Fax:
Practice Address - Street 1:1150 5TH ST STE 270
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2933
Practice Address - Country:US
Practice Address - Phone:319-804-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0853361041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker