Provider Demographics
NPI:1063082220
Name:SMITH, STEPHANIE ANN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2126
Mailing Address - Country:US
Mailing Address - Phone:561-512-7670
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSE BLVD
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2498
Practice Address - Country:US
Practice Address - Phone:561-627-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist