Provider Demographics
NPI:1104059310
Name:HART, STEPHANIE DAVIS (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DAVIS
Last Name:HART
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 NC HIGHWAY 86 N
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9129
Mailing Address - Country:US
Mailing Address - Phone:252-325-1610
Mailing Address - Fax:
Practice Address - Street 1:3714 NC HIGHWAY 86 N
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9129
Practice Address - Country:US
Practice Address - Phone:252-325-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist