Provider Demographics
NPI:1518694330
Name:STEVIE VAN HOUSEN LISW
Entity type:Organization
Organization Name:STEVIE VAN HOUSEN LISW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HOUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW MA ED
Authorized Official - Phone:319-351-4805
Mailing Address - Street 1:2107 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1325
Mailing Address - Country:US
Mailing Address - Phone:319-351-4805
Mailing Address - Fax:
Practice Address - Street 1:2107 10TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1325
Practice Address - Country:US
Practice Address - Phone:319-351-4805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVIE VAN HOUSEN LISW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty