Healthcare Provider Details

I. General information

NPI: 1235221003
Provider Name (Legal Business Name): STEVEN BRUCE PRAY MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 WHITING AVE
STEVENS POINT WI
54481
US

IV. Provider business mailing address

817 WHITING AVE
STEVENS POINT WI
54481
US

V. Phone/Fax

Practice location:
  • Phone: 715-345-5350
  • Fax: 715-345-5966
Mailing address:
  • Phone: 715-345-5350
  • Fax: 715-345-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number214123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: