Provider Demographics
NPI:1043053010
Name:STEVENSON, ELIZABETH R (LSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 6TH STREET FRONTAGE RD E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5162
Mailing Address - Country:US
Mailing Address - Phone:217-504-4027
Mailing Address - Fax:217-529-6154
Practice Address - Street 1:58500 S 6TH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703
Practice Address - Country:US
Practice Address - Phone:217-504-4027
Practice Address - Fax:217-529-6154
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker