Provider Demographics
NPI:1538374913
Name:STEPHANI, JEFF (MSW)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:STEPHANI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W247S10395 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9166
Mailing Address - Country:US
Mailing Address - Phone:262-662-5900
Mailing Address - Fax:262-662-5688
Practice Address - Street 1:W247S10395 CENTER DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9166
Practice Address - Country:US
Practice Address - Phone:262-662-5900
Practice Address - Fax:262-662-5688
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41009800Medicaid