Provider Demographics
NPI:1285962183
Name:STEVENS, PHYLLIS LYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:LYNN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FRISCO CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2390
Mailing Address - Country:US
Mailing Address - Phone:407-880-2274
Mailing Address - Fax:
Practice Address - Street 1:44 FRISCO CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2390
Practice Address - Country:US
Practice Address - Phone:407-880-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890713700Medicaid