Healthcare Provider Details

I. General information

NPI: 1225619935
Provider Name (Legal Business Name): STEFANIE TANJA TOADVINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 MARTIN LUTHER KING JR BLVD
PARIS KY
40361-1282
US

IV. Provider business mailing address

2230 MARTIN LUTHER KING JR BLVD
PARIS KY
40361-1282
US

V. Phone/Fax

Practice location:
  • Phone: 859-435-6375
  • Fax: 859-267-1418
Mailing address:
  • Phone: 859-435-6375
  • Fax: 859-267-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255598
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: