1538830419 NPI number — STEPHANIE HENSON, MSW, LCSW, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538830419 NPI number — STEPHANIE HENSON, MSW, LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHANIE HENSON, MSW, LCSW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538830419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/08/2021
NPI Reactivation Date:
07/26/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 CANNA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLINSVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62234-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-780-8847
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4972 BENCHMARK CENTRE DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-2070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-420-7893
Provider Business Practice Location Address Fax Number:
618-415-4090
Provider Enumeration Date:
09/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HENSON
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SINGLE MEMBER OWNER
Authorized Official Telephone Number:
618-780-8847

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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