Provider Demographics
NPI:1245683713
Name:LOONEY, STEPHANIE MICHELLE (LSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:LOONEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WOLLENHAUPT DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-3263
Mailing Address - Country:US
Mailing Address - Phone:937-718-0114
Mailing Address - Fax:937-949-8074
Practice Address - Street 1:901 WOLLENHAUPT DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-3263
Practice Address - Country:US
Practice Address - Phone:937-718-0114
Practice Address - Fax:937-949-8074
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.13034861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.1303486OtherLICENSED SOCIAL WORKER