MEDICARE: SALLY A STEPHENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	P 693	NE

General Provider Information

NPI Number	:	1013158930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY A STEPHENS

Provider Business Mailing Address
First Line	:	3300 N 60TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-3402
Country	:	US
Telephone Number	:	402-554-0520
Fax Number	:	402-551-8797

Provider Business Practice Location Address
First Line	:	10806 PRAIRIE HILLS DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-4830
Country	:	US
Telephone Number	:	402-898-4135
Fax Number	:	402-551-8797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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Directions to “ SALLY A STEPHENS ” Practice Location

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