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General NPI Number Information
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NPI Number | 1841694296
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Entity Type | Organization
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Legal Business Name | STEPHANIE L. LONSWAY, PH.D., PSYCHOLOGIST, LLC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 1843 RW BERENDS DR SW
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City | WYOMING
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State | MI
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Zip | 49519-4955
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Country | US
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Telephone | 616-773-2908
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Fax |
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Provider Business Mailing Address
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Address Line | 1843 RW BERENDS DR SW
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City | WYOMING
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State | MI
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Zip | 49519-4955
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. STEPHANIE LONSWAY
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Credential | PH.D
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Telephone | 586-291-2503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015757
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License Number State | MI
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