Healthcare Provider Details

I. General information

NPI: 1699578724
Provider Name (Legal Business Name): STEPHANIE DIANE RUNSHE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE DIANE DEMPSEY

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 2ND ST
LONOKE AR
72086-2705
US

IV. Provider business mailing address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-3151
  • Fax: 501-676-3152
Mailing address:
  • Phone: 479-750-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7934-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: