Basic Information
| Provider Information | |||||||||
| NPI: | 1841694296 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHANIE L. LONSWAY, PH.D., PSYCHOLOGIST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1843 RW BERENDS DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495194955 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1843 RW BERENDS DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495194955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167732908 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2014 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | LONSWAY | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5862912503 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301015757 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.