Provider Demographics
NPI:1841779899
Name:WHITE, STEPHANIE JILL (LLBSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JILL
Last Name:WHITE
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N MICHIGAN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4751
Mailing Address - Country:US
Mailing Address - Phone:989-401-9015
Mailing Address - Fax:989-401-9018
Practice Address - Street 1:1320 N MICHIGAN AVE STE 8
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4751
Practice Address - Country:US
Practice Address - Phone:989-401-9015
Practice Address - Fax:989-401-9018
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker