Provider Demographics
NPI:1548741960
Name:GREENWOOD, STEPHANIE JOANN (BS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOANN
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 MARTHA LN
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-2422
Mailing Address - Country:US
Mailing Address - Phone:618-925-3618
Mailing Address - Fax:
Practice Address - Street 1:733 MARTHA LN
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-2422
Practice Address - Country:US
Practice Address - Phone:618-925-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician