Healthcare Provider Details

I. General information

NPI: 1104487024
Provider Name (Legal Business Name): JEFFREY LEE STEFFEN LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N GREEN BAY RD
NEENAH WI
54956-1954
US

IV. Provider business mailing address

1095 MIDWAY RD
MENASHA WI
54952-1115
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-2300
  • Fax:
Mailing address:
  • Phone: 920-720-2300
  • Fax: 920-720-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130766
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9857-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: