Healthcare Provider Details

I. General information

NPI: 1972112787
Provider Name (Legal Business Name): STEPHANIE ANN ISAAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E AVENUE C
BISMARCK ND
58501-3942
US

IV. Provider business mailing address

1334 COLUMBIA DRIVE
BISMARCK ND
58504
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-9962
  • Fax:
Mailing address:
  • Phone: 701-955-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1079-8-1-20
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: