Stephanie Syverson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.017690 Issued in IL

Practice address

5702 Elaine Dr Ste 108
Rockford, IL 61108-2458

Phone

(779) 208-1134

NPI assigned

Mar 10, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1548895527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5702 ELAINE DR STE 108",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082458",
            "telephone_number": "779-208-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5702 ELAINE DR STE 108",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082458",
            "telephone_number": "779-208-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYVERSON",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-10",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.017690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssyverson@myndfulliving.com",
            "affiliation": "N",
            "address_1": "5702 Elaine Dr Ste 108",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "611082458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jawad Syed
• Maliha Syed, M.D., M.B.B.S.
• Kirsten Sympson, COTA
• Joseph Charles Syracuse, DDS
• Jessica Mari Syversen
• Madison Michelle-Saelens Syvertsen, OTR
• Katie Lynn Szarzynski, LCSW
• Elise Christine Tabary Remsen, RD,LDN
• Andrea Tack
• Leigh Ann Tackaberry, M.A., F-AAA

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, 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 Mar 28, 2022; 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.