Healthcare Provider Details

I. General information

NPI: 1902956808
Provider Name (Legal Business Name): BARBARA STEPHANY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 CONNECTICUT AVE S
SARTELL MN
56377
US

IV. Provider business mailing address

8170 33RD AVE S MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-5220
  • Fax:
Mailing address:
  • Phone: 320-253-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5013
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: