Provider Demographics
NPI:1972015899
Name:WARWAS, STEPHANIE RUTH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RUTH
Last Name:WARWAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 GRUNWALD AVE NW
Mailing Address - Street 2:
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358-2334
Mailing Address - Country:US
Mailing Address - Phone:218-851-2089
Mailing Address - Fax:
Practice Address - Street 1:207 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-4667
Practice Address - Country:US
Practice Address - Phone:763-367-6080
Practice Address - Fax:763-263-7897
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health