Provider Demographics
NPI:1124296405
Name:DI STEFANO, DAWN (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:DI STEFANO
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PELICAN DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1600
Mailing Address - Country:US
Mailing Address - Phone:732-237-8830
Mailing Address - Fax:732-237-8836
Practice Address - Street 1:1 PELICAN DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1600
Practice Address - Country:US
Practice Address - Phone:732-237-8830
Practice Address - Fax:732-237-8836
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00418400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist