Provider Demographics
NPI:1528106069
Name:COLE-CONWAY, STEPHANIE DAWN (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DAWN
Last Name:COLE-CONWAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DAWN
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:611 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1309
Mailing Address - Country:US
Mailing Address - Phone:269-388-4819
Mailing Address - Fax:
Practice Address - Street 1:3030 S 9TH ST STE 3G
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9456
Practice Address - Country:US
Practice Address - Phone:269-220-5600
Practice Address - Fax:269-220-5600
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087159104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker