Provider Demographics
NPI:1386481257
Name:PETERS, STELLA C (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:C
Last Name:PETERS
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 1:486 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9561
Mailing Address - Country:US
Mailing Address - Phone:732-589-2236
Mailing Address - Fax:
Practice Address - Street 1:154 E FRONT ST UNIT 9
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1202
Practice Address - Country:US
Practice Address - Phone:631-355-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00842100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist