Healthcare Provider Details

I. General information

NPI: 1821054529
Provider Name (Legal Business Name): STEPHANIE L STRAUSBAUGH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MADISON AVE
COVINGTON KY
41011-1562
US

IV. Provider business mailing address

9925 COBBLESTONE BLVD
INDEPENDENCE KY
41051-8526
US

V. Phone/Fax

Practice location:
  • Phone: 859-291-1121
  • Fax:
Mailing address:
  • Phone: 859-647-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberKY-4484
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS-0025472
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: