Provider Demographics
NPI:1144967449
Name:STEVENS, VICTORIA (BM, MT-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 WESTBROOK ST APT E19
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-6924
Mailing Address - Country:US
Mailing Address - Phone:517-607-8041
Mailing Address - Fax:
Practice Address - Street 1:3283 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9590
Practice Address - Country:US
Practice Address - Phone:269-673-6617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator