Jackie Stephan, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801092663 Issued in MI

Practice address

15700 W 10 Mile Rd Ste 106
Southfield, MI 48075

Phone

(989) 225-4111

Fax

(248) 575-4555

NPI assigned

Aug 29, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550361600000",
    "number": "1275967952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15700 W 10 MILE RD STE 106",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752100",
            "telephone_number": "989-225-4111",
            "fax_number": "248-575-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15700 W 10 MILE RD STE 106",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "989-225-4111",
            "fax_number": "248-575-4555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15700 W 10 Mile Rd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "48075",
            "country_code": "US",
            "telephone_number": "989-225-4111",
            "fax_number": "248-575-4555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEPHAN",
        "first_name": "JACKIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-29",
        "last_updated": "2019-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801092663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marta Sophie Stega, MD
• Nancy Stein
• Stellar Pointe Counseling & Psychological Services LLC
• Rebecca Stenger
• Catherine Lynn Stephan, LMSW
• Johnathan Stephan, MD
• Stephen E. Gork, DDS,PC
• Elaine Marzette Stephens, CRT
• Mark Stephens
• Pharone Stephens

• Clinical Social Worker in Southfield, MI
• Providers in Southfield, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.