Kimberly Ann Stevens, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014203 Issued in IL

Practice address

640 Pierce Blvd Ste 200
O Fallon, IL 62269

Phone

(314) 230-0640

NPI assigned

Nov 3, 2008

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

Other names 1

• Kimberly Ann Grubaugh Former name

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": "1225670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575417600000",
    "number": "1417100504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 PIERCE BLVD STE 200",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692584",
            "telephone_number": "314-230-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 PIERCE BLVD STE 200",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "62269",
            "telephone_number": "314-230-0640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103A South Pointe Drive",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "IL",
            "postal_code": "620253780",
            "country_code": "US",
            "telephone_number": "618-656-2000",
            "fax_number": "618-656-1169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-03",
        "last_updated": "2019-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "GRUBAUGH",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Starrynite Counseling, LLC
• Ashlyn Staves
• Nathan Steadman, DO
• Leia Katherine Stein
• Molly Stephens
• Kylie Marie Stevenson, BEHAVIOR TECHNICIAN
• Michelle Steward
• Still Waters Wellness Counseling LLC
• Michael Vincent Stock, MD
• Robert F Stoelzle, LCSW

• Clinical Social Worker in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.