Provider Demographics
NPI:1619466562
Name:PERDUE, STEPHANIE CARLA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CARLA
Last Name:PERDUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8284 NEWCOMB DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5823
Mailing Address - Country:US
Mailing Address - Phone:440-283-5662
Mailing Address - Fax:
Practice Address - Street 1:205 E CROSIER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-2351
Practice Address - Country:US
Practice Address - Phone:330-643-2145
Practice Address - Fax:330-643-5414
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700488104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker