Provider Demographics
NPI:1801820444
Name:TINDALE, STEPHANIE JO-ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JO-ANN
Last Name:TINDALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:TINDALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:44480 HEYDENREICH RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1546
Mailing Address - Country:US
Mailing Address - Phone:313-729-8160
Mailing Address - Fax:248-858-7201
Practice Address - Street 1:22811 GREATER MACK AVE STE L2
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080
Practice Address - Country:US
Practice Address - Phone:586-335-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010674411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid
MI1883825Medicaid