Healthcare Provider Details

I. General information

NPI: 1801090105
Provider Name (Legal Business Name): STEPHANIE DAWN PERKINS MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W 7TH ST
MOUNT CARMEL IL
62863-1439
US

IV. Provider business mailing address

122 W POPLAR ST
ALBION IL
62806-1037
US

V. Phone/Fax

Practice location:
  • Phone: 618-263-3873
  • Fax:
Mailing address:
  • Phone: 618-445-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: