Provider Demographics
NPI:1649205006
Name:STEVENS, ANNE WARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:WARD
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:86 W SUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1822
Mailing Address - Country:US
Mailing Address - Phone:479-435-6360
Mailing Address - Fax:479-435-6028
Practice Address - Street 1:86 W SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1822
Practice Address - Country:US
Practice Address - Phone:479-435-6360
Practice Address - Fax:479-435-6028
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR97-19P103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141499019Medicaid