Provider Demographics
NPI:1255355517
Name:STEPHENSON, COLLEEN (LICSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:KUSLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:4903 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5376
Mailing Address - Country:US
Mailing Address - Phone:509-327-7714
Mailing Address - Fax:
Practice Address - Street 1:4815 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6185
Practice Address - Country:US
Practice Address - Phone:509-434-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000085651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical