Healthcare Provider Details

I. General information

NPI: 1154971919
Provider Name (Legal Business Name): ROBBILLIE STEVENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 HIGH ST
DECATUR IN
46733-2324
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-724-9669
  • Fax: 260-724-4872
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010444A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: