Provider Demographics
NPI:1013423920
Name:STEMBAUGH, SHARYL LYNNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARYL
Middle Name:LYNNE
Last Name:STEMBAUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 S POTAWATOMI CT
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-8748
Mailing Address - Country:US
Mailing Address - Phone:616-293-5276
Mailing Address - Fax:
Practice Address - Street 1:1 W STATE RD
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-7981
Practice Address - Country:US
Practice Address - Phone:616-414-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105248104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM931265OtherSTATE OF MICHIGAN