Healthcare Provider Details

I. General information

NPI: 1154876621
Provider Name (Legal Business Name): STEPHANIE MANION PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 MAIN ST
GRAND JUNCTION CO
81501-3540
US

IV. Provider business mailing address

1003 MAIN ST
GRAND JUNCTION CO
81501-3540
US

V. Phone/Fax

Practice location:
  • Phone: 970-930-1581
  • Fax: 970-360-0327
Mailing address:
  • Phone: 970-930-1581
  • Fax: 970-360-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0006090
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: