Individual
MS. KATHLEEN A STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
101 W KIRKWOOD AVE, SUITE 212, BLOOMINGTON, IN 47404
(812) 334-0580
Mailing address
101 W KIRKWOOD AVE, SUITE 212, BLOOMINGTON, IN 47404
(812) 334-0580
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34001265A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209392
ANTHEM PIN
IN
Enumeration date
02/03/2006
Last updated
09/27/2007
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