Provider Demographics
NPI:1558197194
Name:CALLAHAN, STEPHANIE L (LSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:CALABRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 BOYD CIR
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7017
Mailing Address - Country:US
Mailing Address - Phone:219-508-0080
Mailing Address - Fax:
Practice Address - Street 1:101 W 18TH ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-6830
Practice Address - Country:US
Practice Address - Phone:219-508-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009558A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker