Active NPI
Suzanne Elia Stephan, LCSW
- Clinical Social Worker
- Rockford, IL
National Provider Identifier
1619246030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149012747
- Practice address
- 8616 Northern Ave
Rockford, IL 61107-5309 - Phone
- (815) 332-6019
- Fax
- (815) 332-6090
- NPI assigned
- Dec 14, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149012747 | IL | Primary |
Addresses
Primary practice location
8616 Northern Ave
Rockford, IL 61107-5309
Mailing address
8616 Northern Ave
Rockford, IL 61107-5309
Phone (815) 332-6019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149012747 | Other | IL | DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149012747 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323820800000",
"number": "1619246030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8616 NORTHERN AVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075309",
"telephone_number": "815-332-6019",
"fax_number": "815-332-6090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8616 NORTHERN AVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075309",
"telephone_number": "815-332-6019",
"fax_number": "815-332-6090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHAN",
"first_name": "SUZANNE",
"middle_name": "ELIA",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-14",
"last_updated": "2011-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149012747",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION",
"identifier": "149012747",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.