MEDICARE: MS. DIANA FAYE STEPHENS MSW, LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150.009512	IL

General Provider Information

NPI Number	:	1568629269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA FAYE STEPHENS MSW, LSW

Provider Business Mailing Address
First Line	:	19892 CAMP SPRING ROAD
Second Line	:
City	:	ASHMORE
State	:	IL
Zip	:	61912-9183
Country	:	US
Telephone Number	:	217-345-3448
Fax Number	:	217-345-3470

Provider Business Practice Location Address
First Line	:	19892 CAMP SPRING ROAD
Second Line	:
City	:	ASHMORE
State	:	IL
Zip	:	61912-9183
Country	:	US
Telephone Number	:	217-345-3448
Fax Number	:	217-345-3470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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