Provider Demographics
NPI:1649083007
Name:WEATHERSPOON, STEPHANIE INEZ (BD,PD, LCCE)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:INEZ
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:BD,PD, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 BANBURY RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5260
Mailing Address - Country:US
Mailing Address - Phone:269-370-8392
Mailing Address - Fax:
Practice Address - Street 1:2229 BANBURY RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-5260
Practice Address - Country:US
Practice Address - Phone:269-370-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20950174H00000X
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator