Healthcare Provider Details

I. General information

NPI: 1497132724
Provider Name (Legal Business Name): STEPHANIE ENNEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 N PARK PL NE # 1031
CEDAR RAPIDS IA
52402-6210
US

IV. Provider business mailing address

5249 N PARK PL NE # 1031
CEDAR RAPIDS IA
52402-6210
US

V. Phone/Fax

Practice location:
  • Phone: 888-270-1924
  • Fax:
Mailing address:
  • Phone: 888-270-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90297
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: