Provider Demographics
NPI:1154012821
Name:EMMONS, STEPHANIE LEA (LISW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEA
Last Name:EMMONS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-6920
Mailing Address - Country:US
Mailing Address - Phone:740-821-5821
Mailing Address - Fax:
Practice Address - Street 1:2922 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-6920
Practice Address - Country:US
Practice Address - Phone:740-821-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23042351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical