Provider Demographics
NPI:1750921466
Name:STEPPA, COLLEEN MARIE (LGSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:STEPPA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 35TH AVE S APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4118
Mailing Address - Country:US
Mailing Address - Phone:612-345-8193
Mailing Address - Fax:
Practice Address - Street 1:333 WASHINGTON AVE N STE 500
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2263
Practice Address - Country:US
Practice Address - Phone:612-345-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26665104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty