1386732543 NPI number — MS. CONSTANCE ANNE STAMPER MSW LCSW

Table of content: (NPI 1679016893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386732543 NPI number — MS. CONSTANCE ANNE STAMPER MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAMPER
Provider First Name:
CONSTANCE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STAMPER
Provider Other First Name:
CONSTANCE
Provider Other Middle Name:
SHERMAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386732543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1534 GREENLEAF BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46514-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-266-1891
Provider Business Mailing Address Fax Number:
574-266-1671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 WEST BRISTOL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46514-2964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-266-1891
Provider Business Practice Location Address Fax Number:
574-266-1671
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34004269A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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