Provider Demographics
NPI:1841625076
Name:RUDOW, STEPHANIE JANE (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JANE
Last Name:RUDOW
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JANE
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 E. MILL ST.
Mailing Address - Street 2:
Mailing Address - City:CAPAC
Mailing Address - State:MI
Mailing Address - Zip Code:48014
Mailing Address - Country:US
Mailing Address - Phone:586-372-1939
Mailing Address - Fax:
Practice Address - Street 1:1570 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446
Practice Address - Country:US
Practice Address - Phone:810-667-0500
Practice Address - Fax:810-664-8728
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)