Provider Demographics
NPI:1639516990
Name:PHILLIPS, STEPHANIE ANN (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:PHILLIPS
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 1:2803 AKRON RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7904
Mailing Address - Country:US
Mailing Address - Phone:216-447-9600
Mailing Address - Fax:216-447-9603
Practice Address - Street 1:7565 GRANGER RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-4818
Practice Address - Country:US
Practice Address - Phone:216-447-9600
Practice Address - Fax:216-447-9603
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.08002381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical