Provider Demographics
NPI:1710320213
Name:STEVENSON, EMILY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7987 63RD ST S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-6019
Mailing Address - Country:US
Mailing Address - Phone:612-743-5889
Mailing Address - Fax:
Practice Address - Street 1:901 4TH ST STE 165
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016
Practice Address - Country:US
Practice Address - Phone:612-743-5889
Practice Address - Fax:763-210-6886
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health