Provider Demographics
NPI:1568629269
Name:STEPHENS, DIANA FAYE (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:FAYE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19892 CAMP SPRING ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHMORE
Mailing Address - State:IL
Mailing Address - Zip Code:61912-9183
Mailing Address - Country:US
Mailing Address - Phone:217-345-3448
Mailing Address - Fax:217-345-3470
Practice Address - Street 1:19892 CAMP SPRING ROAD
Practice Address - Street 2:
Practice Address - City:ASHMORE
Practice Address - State:IL
Practice Address - Zip Code:61912-9183
Practice Address - Country:US
Practice Address - Phone:217-345-3448
Practice Address - Fax:217-345-3470
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.009512104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker