Provider Demographics
NPI:1619251733
Name:DAUGHERTY-DENNIS, STEPHANIE A (MSW, CISW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:DAUGHERTY-DENNIS
Suffix:
Gender:F
Credentials:MSW, CISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2727
Mailing Address - Country:US
Mailing Address - Phone:608-316-5687
Mailing Address - Fax:
Practice Address - Street 1:2000 ENGEL ST STE 201
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4822
Practice Address - Country:US
Practice Address - Phone:608-440-9029
Practice Address - Fax:608-455-0883
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health