Healthcare Provider Details

I. General information

NPI: 1891753125
Provider Name (Legal Business Name): STEPHEN L ANDERSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 S 16TH ST SUITE 219
MILWAUKEE WI
53204
US

IV. Provider business mailing address

2906 S 20TH ST SUITE 219
MILWAUKEE WI
53215-3732
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-3145
  • Fax: 414-383-5597
Mailing address:
  • Phone: 414-897-5511
  • Fax: 414-385-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number976123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: