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General NPI Number Information
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NPI Number | 1043053010
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Entity Type | Individual
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Provider Name | ELIZABETH R STEVENSON LSW
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Gender | Female
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 58500 S 6TH STREET
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City | SPRINGFIELD
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State | IL
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Zip | 62703
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Country | US
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Telephone | 217-504-4027
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Fax | 217-529-6154
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Provider Business Mailing Address
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Address Line | 5850 6TH STREET FRONTAGE RD E
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City | SPRINGFIELD
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State | IL
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Zip | 62703-5162
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Country | US
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Telephone | 217-504-4027
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Fax | 217-529-6154
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.108503
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License Number State | IL
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