Provider Demographics
NPI:1679969943
Name:GROW, STEPHANIE LYNNE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:GROW
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 1:3517 WHITE CLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-9737
Mailing Address - Country:US
Mailing Address - Phone:317-362-2094
Mailing Address - Fax:
Practice Address - Street 1:3517 WHITE CLIFF WAY
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-9737
Practice Address - Country:US
Practice Address - Phone:317-362-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator