Provider Demographics
NPI:1356975643
Name:STEVENS, JAMIE SUE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-9630
Mailing Address - Country:US
Mailing Address - Phone:217-621-8533
Mailing Address - Fax:
Practice Address - Street 1:201 W SPRINGFIELD AVE STE 208
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4875
Practice Address - Country:US
Practice Address - Phone:217-621-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional