Provider Demographics
NPI:1154945756
Name:DORTON, STEPHANIE KAY MARIE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:KAY MARIE
Last Name:DORTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4824
Mailing Address - Country:US
Mailing Address - Phone:309-283-1301
Mailing Address - Fax:
Practice Address - Street 1:2611 W 35TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5222
Practice Address - Country:US
Practice Address - Phone:563-370-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0221701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical