Healthcare Provider Details

I. General information

NPI: 1265657514
Provider Name (Legal Business Name): STEPHANIE PAIGE MADDEX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LINCOLNWAY STE 2
VALPARAISO IN
46383-6722
US

IV. Provider business mailing address

1481 LOBWEDGE LN
CHESTERTON IN
46304-9171
US

V. Phone/Fax

Practice location:
  • Phone: 219-252-4298
  • Fax:
Mailing address:
  • Phone: 219-252-4298
  • Fax: 219-921-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005317A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: