Provider Demographics
NPI:1750615886
Name:STOWMAN, STEPHANIE ANN (PHD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:STOWMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11176 MONTAGNE MARRON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3870
Mailing Address - Country:US
Mailing Address - Phone:702-690-5943
Mailing Address - Fax:702-446-3900
Practice Address - Street 1:2470 SAINT ROSE PKWY
Practice Address - Street 2:STE 106C
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7773
Practice Address - Country:US
Practice Address - Phone:702-690-5983
Practice Address - Fax:702-446-3900
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0623103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EY135AMedicare PIN