Provider Demographics
NPI:1265893820
Name:DE ROO, STEPHANIE QUINN (NCC, LMHC (T), MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:QUINN
Last Name:DE ROO
Suffix:
Gender:F
Credentials:NCC, LMHC (T), MS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 2ND AVE SE
Mailing Address - Street 2:SUITE NUMBER 205
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 2ND AVE SE
Practice Address - Street 2:SUITE NUMBER 205
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2368
Practice Address - Country:US
Practice Address - Phone:319-739-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health