Provider Demographics
NPI:1386732543
Name:STAMPER, CONSTANCE ANNE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANNE
Last Name:STAMPER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:CONSTANCE
Other - Middle Name:SHERMAN
Other - Last Name:STAMPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:1534 GREENLEAF BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3721
Mailing Address - Country:US
Mailing Address - Phone:574-266-1891
Mailing Address - Fax:574-266-1671
Practice Address - Street 1:501 WEST BRISTOL STREET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2964
Practice Address - Country:US
Practice Address - Phone:574-266-1891
Practice Address - Fax:574-266-1671
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004269A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
409949OtherVALUE OPTIONS