Individual
STEPHANIE BROADBENT BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LISW
Contact information
Practice address
2319 CATSKILL CT, IOWA CITY, IA 52245-5250
(319) 621-9581
Mailing address
533 N 450 E, SPRINGVILLE, UT 84663-3402
(319) 621-9581
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008091
IA
1041C0700X
Clinical Social Worker
6656502-3501
UT
1041C0700X
Clinical Social Worker
6656502-3502
UT
Other
Enumeration date
08/14/2007
Last updated
10/03/2013
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