Provider Demographics
NPI:1134347909
Name:STEVENSON, BERNADETTE MIETUS (MD, PHD)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MIETUS
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 W HIGGINS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2753
Mailing Address - Country:US
Mailing Address - Phone:224-361-3301
Mailing Address - Fax:405-337-9658
Practice Address - Street 1:8745 W HIGGINS RD STE 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2753
Practice Address - Country:US
Practice Address - Phone:224-361-3301
Practice Address - Fax:405-337-9658
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361252722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry